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Measey Surgical Skills Suite

PGY1 Curriculum - BLOCK 1
DAY 1
Morning Session
Overview Tools Objectives References
Introduction to the Simulation Center PowerPoint Overview of the SImulation Curriculum ACS/APDS Surgery Curriculum
Knot Tying

Ethicon knot tying manual and video

Tying boards

Learn how to tie hand-knots using a one and two-handed technique
  1. Ethicon Manual available here.
  2. Giddings, FD. Surgical Knots and Suturing (2nd edition). Giddings Studio Publishing, Fort Collins: 2002
Breast, US-guided needle biopsy and Skin Closure

ACS video

Phantom Breast Models

Sonosite

Skin Pads

Introduction to surgical biopsies

Learn to perform a primary skin closure

Perform a needle localization breast biopsy using US

  1. Roses, R, Czerniecki B. Gowned and Gloved Surgery: Ch. 23 Sentinel Lymph Node Biopsy and Axillary Dissection.
  2. Stereotactic Core-Needle biopsy of the Breast: A Report of the Joint Task Force of the American College of Radiology, ACS and College of American Pathologists. A Cancer Journal for Clinicians May/June 1997; 47(3): 171-190.
  3. The Uniform Approach to Breast Fine-Needle Aspiration Biopsy. The American Journal of Surgery, October 1997; 174: 371-385.
 
DAY 1
Afternoon Session
Overview Tools Objectives References
Tissue Handling Skin Pads
ACS video

Perform a simple interrupted stitch, a simple running stitch, and a subcuticular stitch

Perform a vertical and horizontal mattress stitch

Perform flap closures (VY advancement and Z-plasty)

  1. Galli, SKD and Constantinides, M. Wound Closure Technique. Emedicine website.
    (click here)
  2. Zuber, TJ. The Mattress Sutures: Vertical, Horizontal, and Corner Stitch. American Family Physician, Dec 15, 2002; Vol 66(12): 2231-2236.
Instrument Recognition PowerPoint
Surgical Instruments
Identify the most commonly used surgical instruments
  1. ACS/APDS Surgical Skills Curriculum for Residents Phase 1: Module 1 Asepsis & Instrument Identification Part 2 of 2.
Asepsis

ACS video

Surgical Gowns, masks, and drapes

Learn how to scrub, glove, and gown maintaining a sterile technique

Learn the open and closed gloving technique

Learn a safe way to remove dirty gowns, gloves, and mask

  1. The College of Physicians and Surgeons of Ontario. Infection Control in the Physician's Office, 1999.
  2. Lloyd AT. Positioning for Surgery. A Review of the Physiology and Complications. Advances in Anesthesia, 1998, vol 15: 309-337.
  3. Gruendemann BJ, Meeker MH. Alexander's Care of The Patient in Surgery, 8th ed. The C.V. Mosby Company, St. Louis, Missouri, 1987.
 
DAY 2
Morning Session
Overview Tools Objectives References
Airway management

PowerPoint

ACS video

Airway Mannequins

Surgical airway models

Understand the principles of oxygen delivery and extraction

Understand how to use different oxygen therapy modalities
Perform an endotracheal intubation

Perform a surgical cricothyroidotomy

  1. Barker T. UpToDate: Basic Airway management. Available at www.uptodate.com. Jan 2012.
  2. Ciaglia P, et al. Elective percutaneous dilational tracheostomy: A new simple bedsid procedure. Preliminary Report. Chest 85: 715, 1985.
ABG PowerPoint

Understand acid-base disorders

Learn how to interpret ABGs

  1. Williams AJ. ABC of Oxygen: Assessing and interpreting arterial blood gasses and acid-base balance. BMJ 1998; 317:1213.
Principles of mechanical ventilation PowerPoint

Understand the principles behind mechanical ventilation

Familiarize with the most commonly used modes of ventilation

  1. Maung AA, Kaplan LJ. ACS Surgery principles & Practice: Mechanical ventilation. Available at here.
 
DAY 2
Afternoon Session
Overview Tools Objectives References
Surgery Skills Assessment Surgical skills suite

Perform basic surgical tasks and recognize some surgical instruments

Evaluate the participant's baseline surgical technique and skills

 
 
DAY 3
Morning Session
Overview Tools Objectives References
Sutures

PowerPoint

Covidien sutures

Learn to differentiate different types of suture and their uses Covidien at www.covidien.com
Energy sources in the OR PowerPoint Understand the potential risk for burns and fires in the OR Covidien at www.covidien.com
Staplers

PowerPoint

Covidien staplers

Learn the differences between a TA, GIA, and EEA

Learn how to use stapling devices in the OR

Covidien at www.covidien.com
 
DAY 3
Afternoon Session
Overview Tools Objectives References
Fundamentals of laparoscopic surgery (FLS)

FLS box

FLS materials, suture and laparoscopic instruments

Train residents on the basic laparoscopic exercises

www.FLSprogram.org
 
DAY 4
Morning Session
Overview Tools Objectives References
OR Team Training Simulated OR
Laerdal® SimMan 3G
Respond to a simulated OR emergency  
Melanoma

PowerPoint

Skin pads

Understand melanoma screening, diagnosis and management

Perform a wide excision biopsy

  1. Wargo JA, Tanabe K. ACS Surgery principles & Practice: Surgical Management of Melanoma and Other Skin Cancers. Available at here.

Central lines

Arterial lines

ACS videos

Central line and arterial line trainers

Sonosite

Arrow CVC and Arterial line kits

Identify the anatomic landmarks to safely place arterial and central venous catheters

Develop an algorithm to maximize safety in placement of arterial and central venous lines

Place an IJ, subclavian, and femoral central venous line

Place a radial and femoral arterial lines

  1. Tips for monitoring the position of a central venous catheter, how placement can go awry - even when the anatomy is normal". Journal of Critical Illness 1993, 8: 660-74.
  2. Invasive hemodynamic monitoring: concepts and practical approaches. Ann Med 1997 Aug;29(4): 313-318.
 
DAY 4
Afternoon Session
Overview Tools Objectives References
Virtual reality simulators

Simbionix® Lap Mentor

Surgical Science® Lap Sim

Mimic® dV Robotic Trainer

SIMENDO® Laparoscopic Trainer

Train residents in basic laparoscopic tasks using high-fidelity simulators

Perform laparoscopic procedures (laparoscopic appendectomy, lap cholecystectomy, lap ventral hernia, lap GBP)

 
 
DAY 5
Morning Session
Overview Tools Objectives References
Inguinal hernia

Open inguinal hernia training models

Surgical instruments, suture, and mesh

Recognize the key anatomic structures of the inguinal region

Understand the role of mesh in hernia repair and associated complications

Understand the different surgical echniques involved in open vs laparoscopic inguinal hernia repairs

Perform a Lichtenstein repair using mesh

  1. Sabiston Textbook of Surgery, 17th Edition. Chapter 42, Hernias: 1199-1212, Elsevier Saunders.
  2. Kurzer M, Belsham P, Kark A. The Lichtenstein Repair for Groin Hernias. Surgical Clinics of North America October 2003: 1099-1117.
 
DAY 5
Afternoon Session
Overview Tools Objectives References
ACLS

Simulated hospital room

Laerdal® SimMan 3G

Perform ACLS mega- codes using the AHA guidelines

Familiarize with ACLS algorithms

Early detection of unstable patients and prompt activation of RRT

  1. American Heart Association, 2010 ACLS guidelines. Provider's manual.
Knowledge Assessment Score Surgery Questions Evaluate knowledge retention for basic general surgery topics encountered in the ABSITE  
 

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