Plastic Surgery

Educational objectives:
1. Be able to perform and describe a basic hand and wrist exam.
2. Know the appropriate diagnostic tests to order in the evaluation of hand and wrist pain and trauma.
3. Be able to diagnose and come up with a treatment plan for common hand problems, including various nerve compression syndromes (carpal tunnel, Guyon’s canal, and cubital tunnel syndrome), compartment syndrome, ganglion cysts, mucus cysts, De Quervains, Dupuytrens, etc.
4. Feel comfortable with the basic evaluation, diagnosis and management of hand lacerations, and management of tendon and nerve lacerations to the upper extremity.
5. Be able to describe, splint, and in some cases definitively treat various hand and wrist fractures, dislocations, and sprains.
6. Feel comfortable with the management of a fingertip amputation and nail bed repair.
7. Perform the basic physical exam, radiological workup, and evaluation of maxillofacial trauma patients, including some familiarity with common midface and mandible fractures.
8. Be familiar with the significant problems and concerns associated with facial trauma (airway, C-spine, CNS concerns, ophthalmologic concerns, ENT concerns).
9. Understand the basic mechanisms of prevention of treatment of decubitus ulcers.
10. Gain some exposure to various forms of soft tissue coverage, including skin grafts and flaps.
11. An introduction to basic suture principles.
12. An awareness of various complications which may be commonly seen in the ER following plastic surgery.

Description of clinical experiences:
These goals and objectives will be met by a rotation on the Plastic Surgery service during the PGY-1 year. A rotation is available as an elective rotation. This rotation will include the initial evaluation and management of patients with plastic surgery problems, under the supervision of a plastics physician assistant, plastics resident, oral and maxillofacial surgery resident, hand fellow, and/or plastic surgery attending. The EM resident will be first call to the ED on Tuesdays, Fridays and on call days. The EM resident will attend clinics to evaluate various common plastic and hand problems and be encouraged to go to the OR and see common hand procedures such as a carpal tunnel release, closed and ORIF of a hand fractures, nerve repair, and tendon repair. The EM resident will be encouraged to participate in some non trauma operative procedures where they may gain some experience with suturing.
The EM resident rotator will make rounds with the service and be familiar with the diversity, management and care of various patients on the plastic surgery service.

Description of didactic experiences:
The resident will attend the various plastics conferences during the rotation, including the weekly Monday 6:30 am maxillofacial review of trauma cases with ENT from the previous week, and the weekly Wednesday 6:45 am plastic and hand surgery department rounds. In addition the resident will attend other various evening department rounds which may be relevant. This may include the Twin Cities combined maxillofacial rounds held at 5:30 pm in on the first Thursday of the month. The plastics’ attendings will advise the EM resident when the topic is relevant. The residents are expected to attend the emergency medicine conferences held each Wednesday morning.

Evaluation process:
Residents will receive a written evaluation after completing the Hand rotation. Residents are evaluated on their knowledge base, facility in performing procedures, procedural skills, and their facility in communication with patients, family, and other medical personnel. Residents are required to keep a logbook of all procedures performed.

Feedback mechanisms:
Several times during the year the preceptor meets with the resident. In addition, the Program Director will meet with each resident two times per year to review the department evaluation of the residents. More immediate feedback will be provided by faculty on duty on the Hand Service or the Emergency Medicine Department.