Western University
Department of Otolaryngology - Head and Neck Surgery

Plastic Surgery (PGY-1)

Medical Expert

It is recognized that the resident may not be exposed to all elements of these objectives; however at the conclusion of the rotation the resident should demonstrate knowledge or competency in the following:

Perioperative Management of the Surgical Patient:

1. A pre-operative assessment of medical suitability for the given operation
2. Ability to optimize health of patients prior to operation, and consult appropriate services
3. Diagnose and manage common post-operative complications in patient

Nutrition, fluid and electrolytes:

1. Surgical nutrition as applied to wound healing, caloric requirements, enteral and parenteral feeding
2. Awareness and appropriate route of providing nutrition (enteral and parenteral feeding) in post-operative patient
3. Resuscitation of the critically ill patient: assessment, diagnosis, and treatment
4. Ability to manage the acid/base balance in surgical patient

Trauma:

1. Assessment of the trauma patient, ATLS protocols
2. Ability to diagnose a trauma patient in need of resuscitation
3. Assessment of the C-spine in trauma
4. Diagnosis and resuscitation of a burn patient
5. Diagnosis and management of inhalation injuries in a burn patient
6. Competent diagnosis and management of pan-facial trauma, incorporating ATLS protocols

Surgical Sepsis

1. Management of wound infections, indications for prophylactic antibiotics
2. Necrotizing soft tissue infections: risk factors, bacteriology, diagnosis, medical & surgical therapy
3. Diagnosis & treatment of shock including septic shock

Plastic Surgery Knowledge:

1. Understand various reconstructive modalities (graft/flap) and their applications/ contraindications
2. Effectively diagnose and manage paediatric craniofacial anomalies (cleft palate, craniosynostosis)
3. Effectively diagnose and manage cutaneous malignancies
4. Demonstrate in-depth understanding of craniofacial anatomy, facial buttresses and zones pertaining to craniofacial trauma
5. Accurately evaluate a craniofacial CT scan

Basic Surgical Techniques

1. Awareness and appropriate use of various haemostatic techniques
2. Awareness and appropriate use of various suture materials
3. Effective assistance at surgery: knowledge of procedure, anticipation of steps
4. Use of basic operating room instruments (scalpel, needle driver, suture, cautery etc.)
5. Basic surgical skills (knot tying, soft tissue handling)
6. Various techniques to open/close wounds
7. Preparation of the operating room for a surgical procedure & understanding of aseptic techniques

Plastic Surgery Procedures:

1. Competent handling of basic plastic surgery instruments
2. Administration of local anaesthesia, including techniques for loco- regional blocks
3. Design and application of various reconstructive modalities (skin grafts, local/regional/free flaps)
4. Effective use of a variety of techniques for soft tissue wound closure (simple/running closure, horizontal/vertical mattress, etc.)
5. Competent handling of various craniofacial plating systems
6. Application of maxillo-mandibular fixation systems
7. Management of intra-operative soft tissue wound complications (irrigation, debridement, staged closures)

Communicator

1. Obtains & synthesizes relevant history from patient and family
2. Dictates/writes clear consultation letters, progress notes, and discharge summaries
3. Establish effective therapeutic relationships with patients/families
4. Able to explain procedures/treatments, options for treatment, complications and morbidity to patients and families in clear and understandable form
5. Prepares, participates, presents effectively in organized rounds and seminars

Collaborator

1. Works with cooperation and respect with nurses, therapists and other members of health care team
2. Consults and works effectively with other medical specialists
3. Maintains professional relationships with other health care providers

Manager

1. Effectively manages multiple tasks & demands on time (ie follows up on reports, prioritizes tasks appropriately)
2. Manages team, delegates tasks and graded responsibility effectively
3. Utilizes health care resources safely, effectively
4. Utilizes information technology effectively
5. Works effectively in a health care organization

Health Advocate

1. Familiarity with important determinates of health affecting rotation specific specialty (ie smoking, obesity) and addresses preventative measures
2. Attentive to issues of public policy for health
3. Advocates on behalf of patients

Scholar

1. Recognizes gaps in knowledge and develops strategies to correct these
2. Reads and prepares for scheduled clinical procedures
3. Acts as effective teacher for medical students, more junior residents, other health care professionals
4. Develops knowledge of current literature/journals and participates in journal clubs
5. Understands principles of basic and clinical research including design and conduct of clinical trials and critical appraisal of scientific literature
6. Takes an evidence-based approach to management problems
7. Accepts and acts on constructive feedback

Professional

1. Recognizes limitations and seeks advice and consultation when needed
2. Exercises initiative within limits of knowledge and training
3. Discharges duties and assignments responsibly and in a timely and ethical manner
4. Reports facts accurately, including own errors
5. Maintains appropriate boundaries in work and learning situations
6. Shows respect of diversity of race, age, gender, sexual orientation, disability, intelligence and socio-economic status