The purpose of these guidelines is to ensure patient safety, enhance the quality of patient care, and improve the training experience of residents. Consistent with the philosophy of progressively increasing individual responsibility, these guidelines are intended to provide the trainee the opportunity for graded levels of responsibility.
These guidelines apply to all residents enrolled in the Core Surgery and General Surgery Training Programs, and attending surgeons of all integrated and affiliated institutions who are involved with the UCLA General Surgery and Core Surgery Training Programs.
a. limited experience of the resident
b. increased acuity of the patient's condition (e.g. transfer to intensive care unit, need for higher level of clinical care, etc.
c. higher risk of complication or mortality associated with the clinical intervention being considered
d. end of life decisions or initiation of "no CPR" order per hospital protocol
Consistent with the philosophy of graded levels of responsibility, it is expected that the resident will directly communicate with, and be, in turn, supervised by the most senior supervising resident on their assigned surgical team. In turn, it is expected that the most senior supervising resident will directly communicate with the designated attending surgeon. In urgent of emergent situations, immediate communication with the attending surgeon by any resident on the team is expected.
a. Patient Management Competencies:
• evaluation and management of a patient admitted to hospital, including initial history and physical examination, formulation of a plan of therapy, and necessary orders for therapy and tests.
• pre-operative evaluation and management, including history and physical examination, informed consent, formulation of a plan of therapy, and specification of necessary tests
• evaluation and management of post-operative patients, including the conduct of monitoring, and orders for medications, testing, and other treatments
• transfer of patients between hospital units or hospitals
• discharge of patients from the hospital
• interpretation of laboratory results
b. Procedural Competencies
• performance of basic venous access procedures, including establishing peripheral intravenous access
• placement and removal of nasogastric tubes and Foley catheters
• arterial puncture for blood gases
a. Patient Management Competencies
• initial evaluation and management of patients in the urgent or emergent situation, including urgent consultations, trauma, and emergency department consultations (ATLS required)
• evaluation and management of post-operative complications, including hypotension, hypertension, oliguria, anuria, cardiac arrythmias, hypoxemia, change in respiratory rate, change in neurologic status, and compartment syndromes
• evaluation and management of critically-ill patients, either immediately post-operatively or in the intensive care unit, including the conduct of monitoring, and orders for medications, testing, and other treatments
• management of patients in cardiac or respiratory arrest (ACLS required)
b. Procedural Competencies
• carry-out of advanced vascular access procedures, including central venous catheterization, temporary dialysis access, and arterial cannulation
• repair of surgical incisions of the skin and soft tissues
• repair of skin and soft tissue lacerations
• excision of lesions of the skin and subcutaneous tissues
• tube thoracostomy
• endotracheal intubation
• bedside wound debridement