Transcript Document

Vascular Service
Curriculum 2010-2011
St Luke’s-Roosevelt Hospital
Division of Vascular Surgery at
St Luke’s – Roosevelt
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Plans to lead the way to maximizing
the resident staffs’ learning
experience
Our goal as a faculty is “to train the
resident staff to be the best clinicians
they can be.”
PGY level and campus specific core
knowledge and process goals; these
are to serve as focus points to
maximize your Adult Learning
process.
Expectation of residents
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Operating room
Cath lab
Clinic/Office
In patient management
Academic performance
Operating Room:
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All interns/residents will know what case(s) they are
scrubbing the following day
They will be expected to have read the appropriate section
in “Cameron” for the case, (at a minimum)
They will be prepared to answer questions prior to and
during the case as to the pre-operative evaluation, the
intra-operative decision making and the post operative
management of the patients
They may be asked to leave the operating room if they are
not prepared.
Therefore, you must know what case you are doing the
next day prior to leaving the hospital.
Cath Lab
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This is an unique opportunity
This represents how up to 70% of long leg
revascularizations are done
You need to gain experience before you
can gain independence
If your taken care of them; you should
have operated on them….
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Tuesdays – Dr Mendes – ST Lukes OR
Wednesdays – Dr Lantis – 3 rd Floor cath lab
Thursdays – Dr Lee – 3 rd Floor cath lab
Fridays – Dr Benvenisty/Dr Lee – 3 rd Floor
cath lab
Clinic:
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For members of the Vascular
Service, NO OTHER clinic
supercedes vascular clinic.
The goal of clinic is to learn the
outpatient management of the
patient with vascular and general
surgical disease.
In addition it is to provide continuity
of care.
Roosevelt Clinic
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Clinic occurs on the second and
fourth Friday of the Month. From 1
pm – 4 pm. This clinic is staffed by
Dr. Lee.
There is also vascular office on
Monday and Wednesday in 5G77
staffed by Dr. Todd. (Attendance in
Clinic on Monday and Wednesday is
by arrangement with Dr Todd)
St Luke’s Clinic
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Monday – 12th Floor 1090 Amsterdam 9 - 5 – Dr
Benvenisty
Monday – 7th Floor 1090 Amsterdam 11-3 – Dr
Mendes
Tuesday -7th Floor 1090 Amsterdam 9-5 Dr Lantis
Wednesday – 7th Floor 1090 Amsterdam 10 - 5 Dr
Lee
*Thursday – 12th Floor 1090 Amsterdam 9-5 (2 days
per month) Dr Benvenisty
*Thursday – 7th Floor 1090 Amsterdam 11-3 – Dr
Mendes
Friday – 7th Floor 1090 Amsterdam – 9 - 5 – Dr
Lantis
Clinic Coverage Schedule
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Monday:
Mendes - PGY1
Benvenisty PGY2 or PGY4
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Tuesday
Lantis - Anybody if free from other duties
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Wednesday
Lee - PGY2
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Thursday
Benvenisty: PGY2 or 4
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Friday
Lantis - PGY 1 and PGY4
Note: If you aren’t doing anything you should be in clinic, when you get out you will NEVER say you
have had TOO MUCH clinic
Floor Management:
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The vascular surgery patient represents the most
complex and ill patient type that the surgical
resident will encounter.
They require a comprehensive approach, just
getting a medical consult is not the way to think
about these problems.
On a daily basis each patient’s problem list needs
to be reviewed, and more importantly acted
upon.
• Abnormal lab values need to be corrected, or addressed
as to why they are not being corrected. Fluid status and
wounds need to be assessed daily. Antibiotics need to
be chosen based on objective data.
Floor Management
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It is the responsibility of the senior
resident to make sure that the junior
resident understands the medical
management of each patient, and the
junior resident instructs the interns.
However, ultimately it is the Attending
surgeons’ responsibility.
Wound management – wounds may need
intervention not just dressings; why wet
to dry may be good?
Notes:
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Notes: The daily progress note on the
Vascular patient should state at the top:
• Hospital day/Post operative day
• Anti-biotic day (and what anti-biotic)
and FOR WHAT ORGANISM(S)
• The labs are to included in the daily note
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These are not chores these are
opportunities to learn. In addition it is the
residents job to ask;
• why is this patient in the hospital?
• what am I doing to get them better today?
• …..the answer to this should be evident daily…
Walk Rounds/Teaching Rounds:
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At present there is a once a month formal
walk round schedule.
However: dailyAttendings and residents are encouraged
to find each other and make co-joined
rounds on patients as their schedules
permit.
As vascular attending and coverage staff
grows we will try to formalize at least a
weekly – campus walk round schedule.
• Currently planning once a week – walk rounds
Vascular Conference:
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This educational conference remains
weekly on Tuesday Morning from 7-7:45
AM.
This conference is designed to be
RESIDENT DRIVEN, meaning that cases
and topics that the residents have recently
encountered are to be a used as the
fulcrum for discussion.
Core Curriculum
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‘Cameron’ reading
Assigned by levels
Minimum requirement
All reading prior to you level “fair
game”
St Luke’s Campus
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PGY 4/PGY 3/ PGY 1/PGY 1
Roosevelt Campus
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PGY 5/PGY 4/ PGY 2/PGY 1/PGY 1
Roosevelt
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Chief Resident – A Rotation
Abdominal Aortic Aneurysm: Open Repair 703
Abdominal Aortic Aneurysm: Endovascular repair
709
Abdominal Aortic Aneurysm and Unexpected
Abdominal Pathology 718
Brachiocepahlic reconstruction 758
Profunda Femoral Reconstruction 789
Roosevelt
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Chief Resident – B Rotation
Acute Aortic Dissection and its
Complications 729
Upper Extremity Occlusive Disease 801
Acute mesenteric Ischemia 846
Chronic Mesenteric Ischemia 849
Atherosclerotic Renovascular Disease 831
Roosevelt
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Senior Resident
Ruptured Abdominal Aortic Aneurysm 713
Transperitoneal vs. Retroperitoneal Approach to
the Aorta 721
Popliteal and femoral artery aneurysms 732
Carotid endarterectomy 747
Recurrent Carotid Stenosis 751
Balloon Angioplasty and Stents in Carotid
Occlusive Disease 755
Aneurysms of the Extracranial Carotid and
vertebral Arteries 762
Thoracic Outlet Syndrome 840
Roosevelt
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Consult Resident
Nonoperative treatment of claudication 768
Aortoiliac Occlusive Disease 772
Femoropopliteal Occlusive Disease 777
Cardiovascular pharmacology 1141
Acute renal failure 1147
Coagulopathy in the critically ill patient 1184
Peripheral Arterial and Bypass Graft Occlusion:
Thrombolytic Therapy 824
Pulmonary Thromboembolism 876
Vena Cava Filter Placement 879
Reynaud’s Syndrome 838
Roosevelt
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Intern
Fluid and electrolyte therapy 1087
Pre-operative assessment of the elderly
patient 1101
Perioperative care and monitoring of the
surgical patient 1105
Prevention of Venous Thromboembolism in
the Surgical Patient 884
Surgical site infections 1118
The diagnosis of Venous Insufficiency 860
Deep Venous Thrombosis 869
St Luke’s
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Senior /Chief Resident
Thoracoabdominal Aneurysms 723
Tibioperoneal Arterial Occlusive disease
781
Axillofemoral bypass 792
Peripheral Arterial Occlusive Disease:
Angioplasty, Stenting, and Endovascular
Graft Treatment 797
Infected Vascular Graft 808
Peripheral artery embolus 817
St Luke’s
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Consult Resident
Vascular Access 828
False aneurysm and Arteriovenous fistula 741
Buerger’s Disease 821
Vascular Trauma- 984
Penetrating Neck Trauma 1018
Necrotizing Infections of the Skin and Soft
Tissue1082
Gas gangrene of the extremity 1079
Extremity Compartment syndrome 989
St Luke’s
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Intern
Skin lesions: Evaluation, Diagnosis
and Management 1043
Nerve injury 1066
Varicose Veins 864
Venous reconstruction 871
Gangrene of the Foot 813
Management of Lymphedema
AWARDS
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Three awards will be given out by the Division of
Vascular Surgery to reward outstanding
achievement while on the Vascular Surgery
Rotation.
The recipients will be agreed upon by the
Vascular Surgery Attending Staff.
• Appropriate patient management, informed input to
clinical and operative care, correct diagnosis and
algortihm
• Participation in conference and teaching rounds, and
active participation in clinic are considered the minimum
requirements.
• The recipient of any of the award(s) may be planning to
pursue a career in any subspecialty, NOT only vascular
surgery
AWARDS
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Each recipient will be announced at the year-end
dinner and the will be able to add the
commendation under Awards Section of their
Curriculum Vitea.
(PGY 4) Outstanding Vascular Senior
Resident: 1-year subscription to Journal of
Vascular Surgery (JR Nitzkorski, MD;)
(PGY 2 or 3) Outstanding Vascular Consult
Resident: 1-year subscription to Annals of
Vascular Surgery (Manu Sanchet(t)i MD, Ryan
Swan, MD)
Outstanding Vascular Intern: 1-year
subscription to Wound Repair and Regeneration
(Liz Myers MD; Ron Ross, MD)