Goals and Objectives
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Faculty: Drs. A. Djalali, H. Lemmens, A. Adriano, T. Angelotti.
Supporting residents: Drs. N. Hasan, V. Moll, V. Tawfik, J. Basarab-Tung
Introduction
We are pleased to introduce the Abdominal Surgery Rotation, which will expose our residents to a variety of abdominal surgical cases (trauma excluded.) Our goals are to achieve proficiency in major abdominal cases and create a harmonious work environment with our surgical colleagues. In this regard, we emphasize the communication aspect between anesthesiologists and surgeons in the operating room: every resident should feel free to ask questions to clarify unclear aspects of the surgery, as well as express his/her concerns about patient-related problems.
Abdominal surgery comprises a large number of cases in our operating rooms at Stanford and will be a major component of the work of every anesthesiologist after residency.
During the rotation, residents should expect feedback at the end of the workday. We encourage residents’ feedback about the faculty and the rotation’s content. Our goal is to update the syllabus based on resident and surgeon feedback. At the end of the rotation each resident will receive an evaluation from directly-involved faculty, which will be based on the input of other individuals participating in patient care in the operating room, e.g., surgeons, nurses, techs etc. The 6 core competency requirements by ACGME will be embedded in the evaluation process.
The abdominal surgery rotation goes beyond the bowel surgery and will include the following type of cases:
- Colorectal and small bowel procedures: tumor resection, bowel obstruction/perforation, fistula repair, ischemic bowel etc.
- Hepatobiliary procedures: Liver resection, bilio-digestive anastomosis, cholecystectomy.
- Pancreas surgery: Pancreaticoduodenectomy (Whipple), pancreas resection, biliary diversion etc.
- Splenectomy.
- Appendectomy.
- Inguinal and abdominal hernia repair.
Our goal is to include a variety of relevant articles collected from journals in anesthesia and surgery. Each article will be reviewed and rated in collaboration with surgical colleagues to ensure a multidisciplinary approach.
Based on the gained knowledge during this rotation we hope that residents will be able to assess patients and formulate a reasonable anesthetic plan.
Medical knowledge
- Anatomy of the abdominal organs, with emphasis of the blood supply.
- Functional anatomy/physiology of the GI-tract, role of hormones and autonomic nervous system.
- Function of splanchnic area as a blood reservoir of the human body.
- Pathophysiology of each abdominal organ and the consequences for anesthesia.
- Consequences of bowel and biliary obstruction.
- Pathophysiology of chronic inflammatory bowel disease and consequences for anesthesia.
- Diabetes mellitus and the GI-tract.
- Physiology of fasting/NPO and consequences for anesthesia.
- Pathophysiology of ischemic bowel.
- Liver disease and portal hypertension.
- Hypersplenism.
- Coagulopaties and transfusion.
- Drugs and their interactions with GI-tract.
- Effects of aging on GI-tract.
- Role of regional anesthesia for abdominal cases: epidural, TAP-block etc.
Patient care
- Appropriate and effective patient assessment, risk identification and proper planning to address the findings.
- Constructive suggestions to promote patients’ health beyond the hospital stay: weight reduction, smoke cessation etc.
- Identification of proper monitoring for the specific case and proficiency in technical aspect of placement the invasive monitors and interpreting the data.
- Developing strategies to avoid postoperative nausea and vomiting.
- Proficiency in safely managing patients who are not NPO.
- Proficiency in applying NGT in awake patients with or without sedation to reduce the risk of aspiration.
- Proper positioning of patients for laparoscopic procedures.
- Vigilance for intaroperative fluid management to avoid hypovolemia and complications related to hypervolemia.
Interpersonal skills, communication skills and professionalism
- Effective, empathic and polite communication with patients and their families to promote knowledge and reduce anxiety.
- Seeking help and not abandoning the patient and his family in cases of conflicts.
- Collegial and respectful interaction with the OR team and avoiding conflicts.
- Being upfront and asking questions in all unclear situations.
- Seeking help when patients’ safety is at stake.
- Participating and initiating the time-out with the OR team.
- Identifying of and addressing any unprofessional behavior before it leads to conflicts.
- Perceiving critique as an impetus towards improvement rather than personal defeat.
Practice-Based learning and improvement
- After each rotation identify areas that need improvement based on self-reflection and feedback by the faculty.
- Identify at least 3 occasions when you chose to treat a patient without knowing why or when you knew it was contrary to your knowledge.
- Identify at least 2 occasions when you transfused patients and discuss the rational behind it.
- Identify practices in anesthesia that are surgeon-driven and state their reason for it.
- Identify decisions you made during a case that you regretted later.
- Identify areas of uncertainty and work on finding evidence to support or question a practice you did not understood or approved.
- Reflect on daily patient management and make suggestions to improve the insufficiencies.
- Identify useful guidelines and emphasize them.
System-Based Practice
- Review and confirm the preoperative assessment note in EPIC for the patient under your care.
- Be aware of the consequences of your decisions in a larger context of healthcare, patient safety and ethical norms.
- Be familiar with hospital guidelines and keep your self up-to-date with the latest recommendations of different medical societies.
