Surgical Wards- St.

Joseph’s Hospital
Goals, Objectives, and Resident Responsibilities

ROTATION GOAL:
The purpose of the Surgery Wards Rotation at St. Joseph’s Hospital is to provide experience in inpatient
care of the General Surgical patient. Each transitional year resident will spend one month on Surgery
Wards and has the option to spend an additional month in a Surgical Subspecialty as an elective. Although
some operative experience is likely, the focus of this year is primarily in evaluation and management of
patients.

The Faculty at St. Joseph’s Hospital are dedicated to providing the education and leadership necessary to
aid the house staff in achieving and possibly surpassing the following competency goals. The residents are
also to develop a personal program of learning to foster continued professional growth with guidance from
the teaching staff. In addition, they should participate fully in the educational and scholarly activities of
their program and assume responsibility for teaching and supervising other residents and students.

LEARNING OBJECTIVES:
A. Patient Care: Residents are expected to provide patient care that is compassionate, appropriate and
effective for the promotion of health, prevention of illness, treatment of disease and end of life care.
Residents are also expected to:
 Gain experience in operative and non-operative lesions of the head and neck, skin soft tissue and
breast, alimentary tract and the abdomen, vascular diseases, and endocrine diseases.
 Gain experience in the preoperative diagnosis and medical management of patients with this
surgical disease
 Residents will participate in the operative management of patients with lesions of the head and
neck, skin soft tissue and breast, alimentary tract and the abdomen, vascular diseases and
endocrine diseases.
 Gain experience and instruction in the foundations for preoperative evaluation and the
postoperative management of patients who present to the hospital with disorders in the primary
components of General Surgery.
 Play a role in the postoperative management and follow-up of surgical patients.
 Learn appropriate laboratory and imaging techniques involved in defining diseases within the
primary components, for example interpretation of CT scan of the abdomen or mammogram for
breast diseases.
 Acquire the skills necessary to perform focused and accurate history and physical exams.
 Evaluate a sufficient number of surgical patients to gain an appreciation of the important
diagnostic studies used and the indications for surgical intervention.
 Learn the technical aspects of basic procedures including: thorough physical examination,
phlebotomy, intravenous access, insertion of nasogastric and urinary catheters, splinting of injured
extremities, suturing of lacerations, and thoracostomy tube insertion.
 Gain exposure to the long-term follow-up of patients after operation and after discharge from the
hospital including possible side effects of operative intervention and recognizing anticipated
outcomes of specific operative procedures.
 Learn the basics of evaluation, diagnosis and treatment of patients with vascular diseases. This
will include the medical management of vascular disorders including peripheral arterial disease
(PAD), open surgical options, as well as endovascular treatment.
 Become familiar with the management of the elderly and patients with multiple co-morbidities
including diabetes, hypertension and dyslipidemia.
 Determine the appropriateness of operative intervention or invasive radiology care.
 Inform patient and family of end of life concerns, issues, and rights and work with ancillary
services to help with these issues.
B. Medical Knowledge: Residents are expected to demonstrate knowledge of established and evolving
biomedical, clinical and social sciences, and the application of their knowledge to patient care and the
education of others. Residents are expected to:
 Understand fluid and electrolyte balance
 Recognize the importance of nutrition
 Understand the pathophysiology of common disorders such as appendicitis, gastroesophageal
reflux, and inguinal hernias.
 Understand common medical problems associated with the injured patient.
 Recognize non-traumatic emergent surgical conditions.
 Identify patients at risk for iatrogenic complications and pay meticulous attention to detail in their
avoidance.
 Learn the indications for basic procedures including: thorough physical examination, phlebotomy,
intravenous access, insertion of nasogastric and urinary catheters, splinting of injured extremities,
suturing of lacerations, and thoracostomy tube insertion.
 Understand the basic science of the kidney, pancreas, liver and other organs, both the normal and
the abnormal function of these organs.
 Understand the risk factors for atherosclerosis, the associated diseases that occur in vascular
patients, the natural history of vascular disorders, with and without treatment, and the treatment
alternatives available.
 Understanding the basics of acquired heart disease.
 Understand the pathophysiology, diagnosis and treatment of venous disease.
 Learn the principles of preoperative, intraoperative and postoperative care of general thoracic and
cardiac surgical problems.
 Apply an open-minded and analytical approach to acquiring new knowledge.
 Access and critically evaluate current medical information and scientific evidence.

C. Practice-Based Learning and Improvement: Residents are expected to be able to use scientific
evidence and methods to investigate, evaluate, and improve patient care practices. Residents are expected
to:
 Be involvement in programs of patient education and disease prevention
 Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and
processes of care.
 Analyze and evaluate practice experiences and implement strategies to continually improve the
quality of patient practice.
 Develop and maintain a willingness to learn from errors and use errors to improve the system or
processes of care.
 Use information technology or other available methodologies to access and manage information,
support patient care decisions and enhance both patient and physician education.

D. Communication and Interpersonal Skills: Residents are expected to demonstrate interpersonal

communication skills that enable them to establish and maintain professional relationships with patients,
families, and other members of health care teams. Residents are expected to:
 Establish an effective doctor –patient relationship.
 Enhance the faculty-resident interaction in all aspects of patient care.
 Use appropriate language in patient-care areas, and never include the use of expletives, and/or racist
or sexual remarks.
 Provide effective and professional consultation to other physicians and health care professionals
and sustain therapeutic and ethically sound professional relationships with patients, their families,
and colleagues.
 Use effective listening, nonverbal, questioning, and narrative skills to communicate with patients
and families.
 Interact with consultants in a respectful, appropriate manner.
 Maintain comprehensive, timely, and legible medical records.
E. Professionalism: Residents are expected to demonstrate behaviors that reflect a commitment to
continuous professional development, ethical practice, an understanding and sensitivity to diversity and a
responsible attitude toward their patients, their profession, and society. Residents are expected to:
 Be courteous and respectful in all interactions with members of the health care team including
being on time and prepared for rounds and teaching conferences.
 Be businesslike in their demeanor, and always mindful of a patient's right to privacy.
 Provide patient care in a timely and careful manner.
 Be in appropriate attire at all times, including weekends, nights and holidays. Appropriate attire
never includes jeans, tee shirts, shorts or any other informal wear.
 To wear lab coats in-patient care areas; the lab coat should be clean.
 Refrain from use of cigarettes and/or smokeless tobacco inside the hospital, clinics, or on hospital
property.
 Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families,
and colleagues.
 Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference,
socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues.
 Adhere to principles of confidentiality, scientific/academic integrity, and informed consent.
 Recognize and identify deficiencies in peer performance.
 Remain professional in appearance and behavior in the performance of all duties.

F. Systems-Based Practice: Residents are expected to demonstrate both understanding of the contexts
and systems in which health care is provided, and the ability to apply this knowledge to improve and
optimize health care.
 Learn cost effective utilization of resources and how to function in a managed care environment.
 Understand, access, and utilize the resources, providers and systems necessary to provide optimal
care.
 Understand the limitations and opportunities inherent in various practice types and delivery
systems, and develop strategies to optimize care for the individual patient.
 Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease
management.
 Collaborate with other members of the health care team to assist patients in dealing effectively
with complex systems and to improve systematic processes of care.

Resident Activities and Responsibilities:

General Surgery: Thomas V Taylor, MD

Email: thomas.taylor@sjmctx.com
1401 St. Joseph Parkway
George W Strake Building 3rd Floor
Houston, TX 77002
Cell: 281 660-3180

Be sure to check with the Surgery Chief Resident for instructions and call days. The surgery call schedule
is usually made two weeks before the beginning of the month, so check with the Chief Resident early if you
have some days you need to have off (Marivel can provide name and email address). The Surgery Study
Office is in GME area room #3396 on the 3rd floor of the George W Strake Building, door code is #4109.

Neurosurgery: Edward Murphy, MD

Email: ecmurphy@aol.com
Office: 713-795-4300
6550 Fannin #2323
Houston, TX 77030

Dr. Murphy’s office is off-site; please contact his office at 713 795-4300 for instructions.
Ophthalmology: Keith Bourgeois, MD
kab@downtowneye.com
Office Manager: Suzanne Borda
Office: 713-650-0391
Medical Place One
1315 St. Joseph Pkwy #1601
Houston, TX 77002

Please contact Suzanne Borda at 713 650-0391 for instructions.

ENT: Canaan Harris, MD

Email: entplus@yahoo.com
Office: 713-658-1900
Medical Place One
1315 St. Joseph Pkwy #1810
Houston, TX 77002

Please contact Dr. Harris’s office at 713-658-1900 for instructions.

Plastic Surgery: Ernest Cronin, MD

Email: Ernest.cronin@sjmctx.com
Office: 713-951-0400
Medical Place One
1315 St. Joseph Pkwy #920
Houston, TX 77002

Please contact Dr. Cronin’s office at 713-951-0400 for instructions.

Urology: John Bertini, MD

Email: Jbert1024@aol.com
Office: 713-650-1502
Medical Place One
1315 St. Joseph Pkwy #1502
Houston, TX 77002

Please contact Dr. Bertini’s office at 713-650-1502 for instructions.

Call Assignment
Call will be discussed on the first day of the rotation. Residents will be scheduled for no more than 1 call
every 3 days.

Evaluation
Residents will be evaluated at the end of the month by the rotation director through the UTMB evaluation
system.

Supervision of Residents
Each General Surgical service has a faculty person assigned to that service at all times. The faculty
assigned to each of these services participates actively in the supervision, teaching and decision-making at
each of these clinics. As an average, rounds are organized as teaching rounds with bedside discussion of the
specific clinical entities and engagement of both the residents and the students in clinical discussions.
Specific discussions of interpretation of radiographic images and laboratory testing are major components
of these discussions. Where appropriate, the rounds will involve an exercise in the Radiology Department
which will include discussion of the radiographic findings prior to operation or discussion of radiographs of
patients who have had operations to determine postoperative management. The faculty will focus on
developing basic patient management skills for the PGY-1. Intraoperative teaching includes discussion,
demonstration and practicing of techniques of incision, dissection, hemostasis, various anastomoses and
wound closure.
 Qualified faculty supervises all patient care.
 The program director ensures, directs, and documents adequate supervision of residents at all
times.
 Residents are provided with rapid, reliable systems for communicating with supervising faculty.
 Faculty and residents are educated to recognize the signs of fatigue and adopt and apply policies to
prevent and counteract the potential negative effects.

Duty Hours
 The residency program follows the ACGME Duty Hour Requirements.
 Duty hours are limited to 80 hours per week, averaged over a four-week period, inclusive of all in-
house call activities.
 Residents are provided with 1 day in 7 free from all educational and clinical responsibilities,
averaged over a four-week period, inclusive of call. One day is defined as one continuous 24-hour
period free from all clinical, educational, and administrative activities.
 A 10-hour time period for rest and personal activities are provided between all daily duty periods,
and after in-house call.
 The maximum of 24-hour continuous call, followed by up to 6 hours for transfer of care and
educational activities is strictly implemented.