The service performs teaching undergraduate medical students and nursing and postgraduate training to Resident Physiscians ( MIR)
TRAINING PROGRAM MIR:
General and Digestive Surgery is organized in a series of Functionals Units dedicated specifically to groups of diseases. Thereby achieves a high level of expertise of its professionals and clinical protocols homogeneous and efficiency in the correct functioning.
Units set up the current time:
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Gastro-oesophageal Surgery
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Hepato-bilio-pancreatic Surgery
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Colo-rectal Surgery
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Endocrine and morbid obesity surgery
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Breast Surgery
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Abdominal wall surgery
Other lines of work constituted are:
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Emergency surgery
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Multple trauma
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Artificial nutrition
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Infections
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Laparoscopic surgery
The service has accredited a place of training for MIR per year . The training program is based on guidelines of "Comisión Nacional de la Especialidad de Cirugía General y Digestiva" and has a duration of 5 years
There are a tutor appointed for the educational supervision of doctors in training, Dr. Laia Falgueras Verdaguer.
The teaching activity of the service includes:
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Training of specialist doctors on General and Digestiva Surgery (Program MIR).
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Undergraduate training : rotating academic year for Medical students from the universities of Barcelona and Lleida.
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training for residents pysicians (MIR) from other specialties with rotations at General surgery.
TRAINING PROGRAM IN GENERAL AND DIGESTIVE SURGERY OF THE HOSPITAL UNIVERSITARI DE GIRONA:
Period of 5 years of of intense dedication that leads to theadquisition of the appropiate level of competence to practice the speciality of General and Digestive Surgery.
Overall objectives to be achieved at the end of the fifth year :
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Large and profound knowledge of the specialty (Surgery syllabus).
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Skills and experience in managing diseases of this specialty.
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Appropiate use of diagnosis.
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Mastery of surgical indications.
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Mastery of surgical exploratory techniques.
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Complete preoperative evaluation individualized risk-benefit.
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Competence in the common surgical techniques.
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Ressucitation and post-operative care.
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Early detection and treatment of pre and post-operative complications .
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Monitoring of surgical patients in the medium /long term.
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Teaching skills for effective transmission of knowledge / skills to residents / students.
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Scientific skills in the design and implementation of protocols / scientífic / communications / publications.
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Ability to acquire reflective practice and training.
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Skills in doctor-patient communication and interprofessional.
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Acquire attitudes and human qualities to the relationship with patients and their relatives .
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Adaptation to teamwork.
These objectives must be achieved gradually .It combines an immediate "immersion" in the work of the resident in the Service with internal and external rotations. The aim is also a resident physician responsabilization progressive but with supervision adaptyed to the needs of each doctor in training at any given time and and adequate training.
Following the recommendations of the "Comisión Nacional de la Especialidad de Cirugía General y Digestiva" and adapting them to the reality of the Hospital Universitari de Gironaand its General and Digestive Surgery department, the training program has been developed for medical residents.The table below shows for each year of training .
FIRST YEAR RESIDENT (R-1):
- Full integration in the Service of Surgery during those first 12 months
- Generic objectives:
- Completion of the medical record and physical examination of the surgical patient
- Control patients in ward (pre and post-operative)
- Basic surgical techniques :
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Central and peripheral venous access
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Nasogastric tube and bladder
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Wound care
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Abscesses and infections
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Thoracic drainage (extended rotation of Thoracic Surgery )
- Attendance at the Outpatient Service
- Medical care in the operating room:
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Principles of aseptic and antiseptic
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Surgical field
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Familiarity with surgical instruments, type of sutures
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Basic surgical training : anusar, hemostasis...
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Act as a second assistant in complex interventions ( 3, 4 and 5 degrees as defined by the Comisión Nacional),surgical first assistant in grade 1 or 2 and as surgeon in lower complexity (grade 1)
- Realization of the specialization guards.
- Realization of general guards at teh Emergency Unit according to the guidelines of the Teaching Commitee of the Hospital (currently 2 per month during the first year of training)
- Development of study habits
- Assistance and full participation in clinical sessions of the service, inter and general hospital services
- Attendance to the Common Suplementary Program "Programa Comú Complementari (PCC)" that includes modules of:
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Comunicative abilities (doctor-patient and interproffessional)
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Cardio-pulmonary resuscitation
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Scientific methodology I
- Start od research : communications in congresses local / regional
During the first year residents will perform all its activities within the services except for general emergency guards . Will have 12 month to be shared equally between the three sections that divides the Service:
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Section A: Esophagogastric surgery and hepato-biliary-pancreatic
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Section B: Endocrine and morbid obesity surgery . Breast and abdominal wall surgery. Abdominal trauma
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Section C: Colo-rectal surgery
These internal rotations seek a first contact of the resident with the global specialty and should allow their full participation in health care ressources / scientific /teaching staff of the service
SECOND YEAR RESIDENT (R-2):
The second year of residency is dedicated to external rotations (rotationsfor other Services).
For each rotation are definite a time periode and definite learning objectives. These objectives are originated in the need of the surgery resident for training in material and techniques that, even belonging to other specialties, are important for their development as a surgeon .
Obligatory rotations are defined with estabished duration :
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Intensive Care: 3 month
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Vascular Surgery: 3 month
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Urology: 2 month
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Thoracic Surgery: 3 month
During these rotations is intended maximum integration of resident in the service where is rotating . His union with the Surgery Service will remain with the guards regularly performed (the same number as when not are doing external rotations ). Also seek assistance to clinical and educational sessions of Surgery Service if that does not match the service activity which is rotating.
In the second year , referring surgical training , the resident will perform surgeries of degree of complexity 1 and 2 ,and participate as assistant in more complex operations.
THIRD YEAR RESIDENT (R-3):
At this time periode they complete the obligatory external rotation (ldescribed by the R-2) and the resident rejoins the Service of Surgery.
This year theresident will make internal rotations at different functional units of the Service (aa described).Each rotation lasting 6 month,so this year the resident will complete 2 rotations of 6 month in two functional Units of the Service (esophageal-gastro-hepato-biliary-pancreas, colo-rectal and endocrine-breast-abdominal wall-trauma). The order of the is not determinated or fixed
regarding the surgical training, the resident will gradually progress to be able to assume operations of the third degree. As assistant will repeatedley participate in more complexe operations (as second and later as first assistant) , until be able to operate as head surgeon.
At the ward will assume the leading role in the control of patients except those of higher complexity and always under adequate supervision of their phisycian in charge. Will be able to decide the hospital discharge taking the appropiate determinations and making a correct and complete medical report (supervised).
Highlights the very important educational role of the surgery guard ,where the resident will leading role in the diagnosis of acute abdomen and other urgent pathologies (supervised). Begins to be able to indicate urgent operations.
FOURTH YEAR RESIDENT (R-4):
In this period will continue internal rotations betwen different units. The first 6 months (together with 12 months of the third year) can be completestays of 6 month in all the 3 units.
At this time is a possibility of voluntary or optional rotations. In this section the resident can agree, depending on their educational needs, which rotations can be afford. it is recommended not to exceed a period of 3 month because the dedication to General Surgery is a prioprity .
Possible optional rotations:
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Plastic surgery
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Outpatient minor surgery(in a un specifically center)
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Liver major surgery
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Pediatric surgery
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Advanced laparoscopic surgery
This rotations will be made, de preferably , in schools with special prestige in the academic subjects. Opcionally you can postpone this period of rotation for the fith year(R-5) but never on the last 4 month of residence.
The resident achieve a significant share of responsability for the care and decision-making of inpatients, surgical indications , outpatients and emergency situations.The level of supervision by the physician will progressively lower but the possibility of consultation is allways guaranteed.
Concerning the surgical training, will perform surgeries of 4 degree of complexity. Also will assist in more complex surgeries and could start to help residents of inferor course to perform less complex surgeries.
Participation in clinical sessions and presenting cases should be intense.
Presentation of scientific communications at scientific meetings and national conferences.
preparation of scientific publications.
FITH YEAR RESIDENT (R-5):
At the last year 6 month rotations will continue on the different functional units.
There is the possibility of vountary rotation choice of the resident which must be duly reasoned. Suggested examples : rotation in a local hospital, stay in prestige hospital abroad (in this case it will be necessari to have obtained a grant of any organization). Is mandatory to make the last 3 month at own service.
In terms of technical operations will reach grade five of surgeries. Will also assist residents of lower academic years to perform minor surgeries.
In the ward will assume full responsability in caring of inpatients .
At a scientific level are recommended scientific communications in local meetings and elaboration of scientific publications científiques (preferible relatedto work lines of the service).
It can be considered the beginning of doctoral thesis.
Assume responsability in coordinating care and teaching for residents of lower academic year, participation in clinical sessions ,working groups , etc.
HOSPITALSUPLEMENTARY TRAINING PROGRAM:
Surgery residents will follow obligatorelly the Hospital Suplementary Program (Programa Formatiu Complementari del Hospital) for resident physicians.You can find detailed information on objectives , contents, methods and dates to the teaching commitee ( 9th floor).
Summary:
-During the first year:
-Basic vital support: 8 hours
-Communication skills:
-Communication Doctor-Patient: 20 hours
-Communication Inter-Professional: 10 hours
-Scientific Methodology and Epidemiology: 30 hours
-During second year:
-Bioethics: 30 hours
-Scientific Methodology II. Scientific Communication: 20 hours
-During third year:
-healthcare management
-Scientific Methodology III. Biostatistics: 20 hours
THEORETICAL TRAINING PROGRAM IN GENERAL AND DIGESTIVE SURGERY:
Since the academic year 2002-03, the Catalan society of Surgery organizes and teaches a theoretical training program for all surgery resident doctors of Catalonia. These are attended sessions that are held at the Academy of medical Sciences of Catalunya (Barcelona). Are performed mondays from 6 to 8 PM and a frequency of approximately one monthly sessions. The design allows a tour around the theoretical program of the specialty in four years. The catalan society of surgery considers this program as mandatory for all surgeons in training and provides certification of performance. Each resident enroll in the program and gets detailed informations of the sessions via E-mail.
TUTORIING EDUCATIONAL PROCESS:
The Service assigns a TEACHING-TUTOR that monitors and support each resident individually
Tutor's functions are:
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Reception and information to theresident.
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Tracking/ continous monitoring.
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Monitoring compliance training program.
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Participation in the evaluation.
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Coordination/motivation teaching/research.
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Management teaching conflicts.
EVALUATION OF THE TRAINING PROCESS FOR EACH RESIDENT DOCTOR:
The training process for each resident is subject to continous evaluation following the guidelines of the Ministerio de Sanidad y Consumo that dictates the parameters to evaluate and submit to the Teaching Commitee "Comissió de Docència" the forms to be completed. These should be submitted to the Ministerio by the end of the training period.
Contained assessments of all senior doctors and physicians who has been roting the resident. Also adds tracing results of monitoring what the teacher-tutor and is proposed to the Head of Service to make the qualification that will be sent to the Teaching Commitee of the center
Parameters evaluated:
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Health care traininbg: Inpatient medical visit
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Surgical activity : technical skills developed, number and type of interventions as surgeon and as assistant
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Emergency activities : diagnosis and treatment of patient surgical urgent
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Outpatient
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Presentation of clinical cases and scientific sessions
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Review medical reports,surgical reports, and discharge reports
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Participation in protocols / clinical guidelines of the service or functional units
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Activity in the external rotations
Teacher training, theoretical and research :
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Attendance and participation in clinical sessions of the service.
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Attendance at the Hospital's Supplementary Formative Programm.
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Attendance to theoretical classes in Ctalan Society of Surgery (Societat Catalana de Cirurgia).
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Research competence: comunications presentede at conferences / meetings and scientific publications.
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Possibility of theoretical exam annual.
Formation of attitudes:
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Professional responsability.
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Respect for the patient and family.
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Capacity to team work.
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Capacity for initiative and decision making .
An evaluation for each internal or external rotation.
Also performa an annual evaluation (which is the sum of rotations made that year).
Evaluation of the fifth year will be the final evaluation and is sent to the Ministry .
GRADES OF COMPLEXITY OF INTERVENTIONS BY THE COMISION NACIONAL DE ESPECIALIDADES
The valuation is done by comparing an intervention to be evaluated by "prototype" intervention. This valuation is only indicative because the complexity of a particular intervention can join many other factors
GRADE 1- Surgical cleaning and suture a traumatic soft tissue wound / Excision of cutaneous or subcuteneous tumors / Lymph node biopsy / Laparotomy and closure / Hemorroidectomy / Anal fisurectomy.
GRADE 2: Inguinal hernia repair / Appendectomy / Peritoneal dialisis catheter placement and similar.
GRADE 3: Vagotomy and piloroplastia / Simple Cholecystectomy /Simple Mastectomy / Colectomy / Nissen Fundoplication / Splenectomy.
GRAU 4: Cholecystectomy and choledochotomy / Biliary derivations biliars / Partial gastrectomy / Modified radical mastectomy / Subtotal thyroidectomy / Left colectomy.
GRAU 5: Abdominoperineal amputation of the rectum / Rectum anterior resection / total gastrectomy / Radical neck dissection node / Formal hepatectomy / Cephalic duodeno-pancreatectomy / Laparoscopic surgery.
LEARNING OBJECTIVES IN EXTERNAL ROTATIONS:
Intensiva care:
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Respiratory failure. Indications for artificial respiration. Methods of artificial respiration.Basic knowledge of respirators.
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Cardio-pulmonary failure/ Cardio-pulmonary resuscitation technique: Tracheal intubation and cardiac massage.Major arrhytmies. Desfibrilator basic knowledge. Antiarrhythmic drugs.
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Hemodynamic failure: knowing shock. Vasoactive drugs .
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Kidney failure: hemodia-flitration and hemodylisis.
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Severe spsis : diagnosis and treatment.
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Monitoring critical patient .
This rotation will seek preferential contact of the resident with postoperative critical patients or post-trauma without excluding patients with other medical pathologies .
Vascular surgery:
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Clinical management of the patient with vascular pathology. Anamnesis, examination and diagnostics.
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Surgical anatomy.Approaches
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Peripheral venous pathology: resection varicose veins.
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Arterial disease: aortic aneurysma , arterial bypass and other vascular sutures. Limb amputations . Embolectomies. Arterio-venous fistulae.
Urology:
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Clinical mangement of patients with urological disease.
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Surgical anatomy .Approaches (lumbotomia).
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Urinary retention. bladder catheter and percutaneous cystotomy.
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Surgical techniques : nephrectomy,bladder and uretral sutures.
Thoracic surgery:
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Clinical management of patients with thoracic surgical pathology.
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Surgical anatomy. Approaches (thoracotomy).
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Pleural drainage: indications and techcnique.
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Thoracic trauma .
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Pneumotorax. Hemotorax. Emphysema. Pleural dam.
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Pulmonary nodule and lung neoplasm.
SUMMARY ROTATIONS:
-First 6 months: Coloproctology unit: Under direct supervision of teacher tutor . Priority: adaptation to the Service
-Last 6 months: Esophagogastric surgery unit and hepato-biliary -pancretic
-First 3 months: Intensiv Care Unit
-Following 3 months: Vascular surgery
-Following 2 months: Urology
-Following 2 months: Thoracic surgery
-Last 2 months: optional
-6 months: Endocrine-breast- abdominal wall Surgery Unit
-6 months: Colo-proctological Surgical Unit
*Optional possibility of rotation of 3 months during this or the nexts year
-6 months : Gastro-aesophageal and hepato-biliary-pancreatic Surgery Unit
-6 months: Endocrine -breast- abdominal wall surgical Unit
-6 month: Colo-proctological Surgery Unit
-6 month:Gastro-aesophageal and hepato-biliary-pancreatic Surgery Unit
*Possibility of rottion external of 2 month
