PGY1 – SURGICAL FOUNDATION (CORE) - SURGERY ROTATION PROGRAM

As residents in their R1 year are intricately involved in the otolaryngology program, their participation in seminars, lectures, rounds, and academic half days is mandatory. They are expected to be relieved of their clinical duties to participate in these activities.

Rotations and Sites:

The Core surgery year is the first year of training in otolaryngology.  It is a year in which R1’s acquire knowledge and experience in the basic principles of general surgery and develop an ability to apply these.  At the present time, the CORE surgery year is composed of 13 periods; 3 months of General Surgery, 2 months of pediatric surgery, 2 months in SICU, 1 month of Anesthesia, 1 month of Emergency, 1 month of neurosurgery, 1 month of OMF Trauma, 1 month oncology (surgical/radiation), and one month of plastic surgery. Each period corresponds to 4 weeks of training.  The CORE surgery rotations were chosen specifically to provide residents with a sound general surgery background and compliment further training in otolaryngology. The rotations in neurosurgery, oral surgery, plastics as well as the one non surgical elective in radiation oncology are extremely helpful and pertinent to the practice of head and neck surgery. The rotations in maxillofacial, plastics and general surgery expose the R1 to the general principles of trauma and specifically to head and neck trauma.

It should be noted that the Surgical Foundation (CORE) rotations have been modified with extensive resident input such that the surgical rotations are in areas where residents are most likely to get the direct surgical exposure. Surgical Foundation (CORE) program must also comply with the specialty specific rotations required by the Royal College of Surgeons and Physicians of Canada and the American Board of Otolaryngology.

Throughout the R1 year, residents attend weekly Surgical Foundation (CORE) surgery lectures that are compulsory.  In addition, they are freed from their clinical duties to attend otolaryngology academic activities such as hospital rounds, academic half days on Thursday afternoons and the Thursday afternoon grand rounds.  This is not compulsory however it is highly encouraged. Permission to attend must be approved in advance by the Surgical Foundation program.  This ensures an ongoing strong liaison between R1 residents and the department.  At the end of their R2 year, residents can write the “Principles of Surgery Examination” as required by the Royal College of Physicians and Surgeons of Canada.  It is necessary to obtain a pass rate before a resident is eligible to write the Royal College Otolaryngology Exam at the end of their R5 year.

During the Surgical foundation (CORE) year, residents are expected to become familiar with the CanMEDS competency roles. This familiarity is acquired through dedicated seminars at the faculty level, as well as in the Surgical Foundation (CORE) curriculum and formative OSCE surgical fundamentals at the McGill simulation center. R2’s also attend the surgical foundation curriculum teaching session on Wednesday afternoon for the first six months of their training.
 

1.    MEDICAL EXPERT

The role of the medical expert is clearly at the center of any residency-training program.  In the Surgical Foundation (CORE) surgery year, there is a basic grounding in surgical anatomy, physiology and pathophysiology, as well as the management of situations such as shock, cardiac arrest, dehydration, and so on.  During this year, it is expected that residents will learn the diagnostic and therapeutic skills necessary to provide effective patient care and be able to access and apply relevant information to the practice of surgery. They must also learn to work with other services and obtain appropriate consultation as well as obtain appropriate consultation from other allied health care personnel when necessary. These objectives may be achieved through self-directed learning, the occasional involvement of a mentor, and from observing staff role models. In addition, these skills may be acquired through problem-based learning in the form of case studies, interactive CDs, and various other computer programs available.  Wards, clinics and the operating room all provide forums for the development of the medical expert. Residents may be evaluated during their clinical duties, while interacting with patients, at rounds, presentations and at written examinations. The McGill SIM Centre is used for teaching surgical foundation techniques e.g. suture laceration, airway basic management, etc.
 

2.    COMMUNICATOR

While the role of medical expert is paramount and essential, the role of the physician as a good communicator is also crucial. Residents must appreciate early on in their training the importance of establishing good relationships with patients, families, colleagues and allied health care personnel in order to facilitate the elicitation of relevant information and institute appropriate therapy. This involves developing a certain empathy and flexibility towards patients coming from a multitude of cultural and ethnic backgrounds. For patients who are in the ICU, communication may be primarily through next of kin and other close family members.  Occasionally, the use of interpreters is required. Information, which is then collected and used in therapy, must also be discussed with the patient and their family who are involved in the decision making process. This role is taught, to a great extent, by physician role models who demonstrate effective patient/family interaction. Residents are expected to learn the importance of empathy and respect towards patients and their families. They may be observed directly and given feedback while communicating with patients and other allied health care personnel. Residents also learn how to respect patient confidentiality, privacy and autonomy. Residents must maintain clear and accurate records (ex: written or electronic encounters and plans). The residents attend workshops at the Faculty of Medicine for learning the communicator role of CanMEDS.
 

3.    COLLABORATOR

Resident physicians work in partnership with others who are involved in patient care, and it is therefore essential to have the ability to effectively collaborate both with patients and in the setting of a multidisciplinary team of expert health professionals.  During the CORE surgery year, the R1 resident must learn his/her role in interacting effectively in consulting with other physicians and health care professionals to optimize patient care.  Residents must also learn when and how to contribute effectively in other interdisciplinary team activities related to patient care. This role is learned through exposure and participation in multidisciplinary and interdisciplinary activities such as rounds, clinics and other presentations. It is also learned from role models who demonstrate the ability, to effectively collaborate with others. Interdisciplinary teaching sessions also help to build upon the ability to collaborate effectively.  The resident may be evaluated by direct observation, during clinical activities and also by obtaining direct feedback (360 degree) from staff, allied health care personnel, secretarial staff as well as their peers. As part of the collaborator role, residents must learn to work as part of a team. This means being able to share ward-work and operative cases with the common goal of improving services to the patient. Residents attend workshops at the Faculty of Medicine for learning the collaborator role of CanMEDS

4.    MANAGER

Residents entering the R1 level must learn to be managers in multiple areas. On a personal level, the ability to organize prioritize and manage time must be balanced between the work setting and outside activities.  On a day-to-day basis, this ability is extremely important in allowing the timely completion of tasks, particularly as they relate to patient care. This may mean abruptly interrupting one activity to care for an acutely ill patient or performing an urgently needed intervention.  Residents must also learn how to allocate finite health care resources wisely, with knowledge of the cost benefit ratio associated with each resource. Again, this means the ability to prioritize patients who require admission, surgery, diagnostic interventions, or require the use of expensive technology such as magnetic resonance scanning, PET scan etc.

At the R1 level, residents are also introduced to the concept of team management by working with staff and chief residents who function as teachers and role models. They must familiarize themselves with available technologies, their uses, interpretations, diagnostic and therapeutic implications, and balance these with availability and cost.  Residents may be evaluated in the following areas: time management, timely completion of medical records and discharge summaries, punctuality, and other important tasks related to patient care. They are given the tools for the establishment of a successful medical practice through management seminars/workshops provided by the faculty on a yearly basis.
 

5.    HEALTH ADVOCATE

Junior residents must learn to identify the important determinants of health affecting patients and in so doing develop the ability to contribute effectively to improved health either through prevention or treatment. This may take the form of advising patients and their families with respect to risk factors or life style choices which impact health such as tobacco and alcohol.  It may also mean personal involvement in terms of accelerating or facilitating patient access to important services such as radiological imaging or magnetic resonance imaging.  Residents develop proficiency in this role by understanding the advocacy issues in terms of life style issues and other risk factors, and by familiarizing themselves with the health care organization.  This is achieved through self-directed learning, interdisciplinary teaching sessions, participating in effective interventions and assistance, in collaboration with chief residents or staff. By doing this, the resident promotes the health of individual patients, communities and the general population.
 

6.    SCHOLAR

As physicians and specialists, residents must learn the importance of developing and implementing a personal lifelong continuing medical education strategy in order to maintain competence in their chosen field.  At the R1 level, this begins with a rigorous reading program of basic textbooks to acquire the necessary grounding in Surgical Foundation (CORE) surgery.  This continues with ongoing reading in their chosen field or specialty.  Review of the literature in special cases, special patient problems or for purposes of presentations or data collection allows an evaluation of medical information and the development of skills to critically appraise the literature. With knowledge acquisition, residents develop the ability to facilitate learning for patients, house staff, students and other health care professionals. Residents are expected to formulate research questions and acquire the skills to answer these questions by developing and instituting a research plan with the help of supervisor and other resources such as CD’s, textbooks, computer, etc. Self-directed learning constitutes a large part of becoming a scholar and allows for the practice of evidence-based medicine. Additional expertise is acquired through participation at rounds, presentations, and research. Residents may be evaluated in their ability to develop and complete a research project and appropriate literature review on a particular subject.
 

7.    PROFESSIONAL

It is imperative that the resident, at a very early level, learns to appreciate the importance of professionalism in all aspects of his or her career.  This means behaving with integrity, honesty and compassion towards patients, their families, colleagues, and other health care personnel. Health care must be practiced ethically in a manner that is consistent with the obligations of a physician.  Residents are also expected to exhibit appropriate personal and inter-personal professional behavior.  Differences in opinion must be resolved using appropriate language and courtesy.  This type of behavior is learned through direct observation of peers and staff as well as other health care personnel, and yearly workshops/seminars that are held at the faculty and in specialty areas. Consistent feedback must be provided to reinforce appropriate professional and ethical behavior. Illustrative cases, medical legal rounds and ethics rounds also provide adjunctive tools to teach professionalism.

Throughout the R1 year, residents attend weekly Surgical Foundation (CORE) surgery lectures that are compulsory.  In addition, they are freed from their clinical duties to attend otolaryngology academic activities such as hospital rounds, academic half days on Thursday afternoons and the Thursday afternoon grand rounds.  This is not compulsory however it is highly encouraged. Permission to attend must be approved in advance by the Surgical Foundation program.  This ensures an ongoing strong liaison between R1 residents and the department.  At the end of their R2 year, residents are can write the “Principles of Surgery Examination” as required by the Royal College of Physicians and Surgeons of Canada.  It is necessary to obtain a pass rate before a resident is eligible to write the Royal College Otolaryngology Exam at the end of their R5 year.

The residents attend workshops at the Faculty of Medicine for teaching CanMEDS roles including communicator, collaborator, manager and ethics (professional). The Surgical Foundation (CORE) curriculum i.e.: lectures are available on One-45.
       
Throughout the R1 year, residents attend weekly Surgical Foundation (CORE) surgery lectures that are compulsory.  In addition, they are freed from their clinical duties to attend otolaryngology academic activities such as hospital rounds, academic half days on Thursday afternoons and the Thursday afternoon grand rounds.  This is not compulsory however it is highly encouraged. Permission to attend must be approved in advance by the Surgical Foundation program.  This ensures an ongoing strong liaison between R1 residents and the department.  At the end of their R2 year, residents are can write the “Principles of Surgery Examination” as required by the Royal College of Physicians and Surgeons of Canada.  It is necessary to obtain a pass rate before a resident is eligible to write the Royal College Otolaryngology Exam at the end of their R5 year.

The residents attend workshops at the Faculty of Medicine for teaching CanMEDS roles including communicator, collaborator, manager and ethics (professional). The Surgical Foundation (CORE) curriculum i.e.: lecturers are available on One-45.