| Objective |
Continuity of Care |
Resources |
Mechanism / Evaluation |
CME/Noon Conf |
Rotation Cycle |
Faculty Responsible |
1. The QFMR resident will be able to evaluate, stabilize and collaborate with the consulting surgeon in the treatment of surgical emergencies.
Example: Evaluation of acute abdomen, Evaluation of the trauma patient |
ER Experience
Patients for QFMR |
Surgical faculty
ER, FPC faculty
UpToDate.com
Surgical texts in Library |
Rotational Evaluation
Surgery
ER
ATLS - certification available |
Evaluation of a surgical abdomen
Trauma - 1st hour
ATLS CME |
MD of each of the two, one month rotations |
Surgical faculty
QFMR
ER faculty |
| 2. The QFMR resident will show knowledge and demonstrate skill in the preoperative evaluation of the surgical patient |
Patients for QFMR |
MD Consult
UpToDate.com
www.woundinstitutue.com
Surgical textbooks in Library
Faculty |
The QFMR resident will document by providing H&P and Discharge summary care for a patient undergoing a surgical procedure with:
a) a comorbid condition
i) Cardiovascular
ii) Respiratory
iii) Diabetes
In addition the QFMR resident will explain to faculty how to manage patients undergoing surgical procedures who are:
a) on anticoagulants
b) require insulin
c) require prophylactic antibiotics for cardiac valvular conditions
Surgical Faculty evaluation |
Pre-operative Evaluation of the Patient |
Annually |
Documentation to Lorraine LaLond
Explanation of complications etc to any QFMR faculty |
| 3. The QFMR resident will show knowledge and demonstrate skill in the management of the surgical patient postoperatively and show the ability to manage common complications |
QFMR Patients
FP Service
Surgical rotation |
MD Consult
UpToDate.com
Surgical textbooks in Library
Faculty |
Surgical faculty evaluation
FPS evaluations
In addition to H&P/Discharge summaries, the resident will document that they have treated the following postoperative complications:
a) atelectasis
b) fluid/electrolyte
c) management of complications
d) thrombophlebitis and PE and show preventive techniques
e) post-op infection
f) management of patient after surgery requiring anticoagulants |
Postoperative complications
Doctor Care of the Patient |
Due at the tend of the two -- one month surgical rotations |
Documentation to Lorraine LaLond
Explanation of complications etc to any QFMR faculty |
| 4.The QFMR resident will document the surgical skills they have acquired during their time at the QFMR. (This will vary on what the resident intends to do.) |
QFMR Patients
FP Service
Surgical rotation |
MD Consult
UpToDate.com
Surgical textbooks in Library
Surgical faculty
ER, FPC faculty |
Every family physician must have baseline surgical skills. The QFMR resident will either document with procedure notes or demonstrate to faculty the following skills:
a) the ability to place a foley catheter in a male and female patient's bladder
b) the ability to start an IV
c) the ability to obtain a specimen of blood
d) the ability to repair a laceration on the face and extremity
e) the ability to use local anesthesia appropriately
f) the ability to apply an UNA boot -- know indications and contraindications
g) the ability to remove cerumen impaction from ear canal
h) the ability to I&D a simple abscess or boil
i) the ability to obtain a punch biopsy of the skin
j) the ability to change a surgical dressing, remove a drain and remove post-op staples and sutures
The following is a list of other skills that not all family physicians possess and it is strongly encouraged that every procedure on this list be documented and saved for the credentialing process. (For specific numbers recommended, speak with surgical faculty and/or the program director.) Use New Innovations Procedure Logger.
A)Chest tube placement
B) Central line placement
C) Ventilator management
D) Thorocentesis
E) Paracentesis
F) Flexible sigmoidoscopy
G) Vasectomy
H) Colposcopy
I) Treadmill testing
J) 1st Assistant surgical skills
K) Toenail removal
L) Newborn circumcision
M) Lumbar puncture
The following skills are beyond the scope of most family physicians and require additional training beyond residency. QFMR graduates possess some of these skills. In today's world to learn these skills requires additional training beyond your residency. If you desire these skills, they are realistically attainable but will require some forethought and planning that should start ONLY AFTER YOUR FIRST YEAR OF TRAINING:
- c-sections
- colonoscopy/endoscopy
- office procedures requiring conscious sedation
- surgical procedures requiring general anesthesia |
ATLS
ACLS
National Procedure Institute
Procedure tapes and books in library (Pfenninger) |
Document procedures in New Innovations
Should be done at end of each month
Don't put this off; the credentialing process requires it. |
Documentation to Lorraine LaLond and MaryAnn Epley.
Any faculty |
5. The QFMR resident will understand and integrate his/her role in the care for the surgical patient.
Explanation - As family physicians it is rare that we are in the surgical suite during the operation. So what is our role? In the hospital objectives 1, 2 and 3 outline the "mechanics" of the care of a surgical patient but our role is much more than that. Communication with the patient and family is the most important part of our job. Why do we make rounds on our patients in the hospital when they have surgery? We manage many of the medical complications and the surgical ones in collaboration with the surgeon. Some physicians "just make social rounds" and let the surgeon handle the acute hospital care. This "social" responsibility has been shown time and again (in studies, etc) to be valued as one of the most important, if not the most important part of care by patients. The consulting surgeon knows the patient well, but only for a few days or months. We know the patient for the rest of their life. Do not underestimate how much your presence, explanation, and communication with the family members mean to your patients and improves their surgical outcome. |
QFMR Patients
FP Service
Surgical rotation |
MD Consult
UpToDate.com
Surgical textbooks in Library
Surgical faculty
ER, FPC faculty |
Every family practice resident must not only be proficient but must show excellence in the following:
a) ability to communicate with the patients and family about the death or major surgery involving one of their family members.
B) ability to explain End of Life and Quality of Life issues
c) ability to obtain informed consent from patients
The QFMR resident will:
1) provide a taped interview with a patient showing interview skills in one of the above-named areas. (Mrs. Kewney and Mrs. Longlett can help.)
2) a letter from a patient and/or patients family member describing your ability to communicate with them.
Communication is the core skill in family practice. If you are hesitant about either of these requirements, make an appointment with Dr. Daniels or your advisor STAT. |
See Behavior Science curriculum
End of Life
Quality of Life Decisions |
Due at end of surgical rotations but get it done....
The sooner, the better |
Dr. Daniels
Rhonda Kewney
Shirley Longlett
We won't sign off on your graduation from QFMR until this task is not just done, but done well. |
