Principles of surgery

PART I
Basic Considerations

CHAPTER 1
Accreditation Council for Graduate
Medical Education Core Competencies

1. Learning by presenting errors at a morbidity and mortality conference is a part of which of the following ACGME core competencies?

A. Patient care

B. Medical knowledge

C. Practice-based learning and improvement

D. System-based practice

Answer: C

Practice-based learning and improvement involves a cycle of four steps: identify areas for improvement, engage in learning, apply the new knowledge and skills to a practice, and check for improvement…. In residency training, the simplest example of practice-based learning is the surgical morbidity and mortality conference. This conference traditionally allows for in-depth discussions of surgical cases and adverse patient outcomes. Complications are categorized (preventable, probably preventable, possibly preventable, and unpreventable) and areas of improvement are identified. (See Schwartz 9th ed., p. 6, and Table 1-1.)

TABLE 1-1 Accreditation Council for Graduate Medical Education core competencies

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2. Which of the following are mandated by the Residency Review Committee of the ACGME?

A. One-on-one teaching with attending surgeons

B. Surgical skills laboratory

C. Departmental library with Internet access

D. Morning report

ANSWER: B

Having recognized the importance of incorporating simulation training into today’s residency, the Residency Review Committee (RRC) mandated that all surgery programs be required to have a surgical skills laboratory by July 2008 to maintain their accreditation. One-on-one teaching as well as conferences such as morning report occur in almost all surgical training programs. They are not, however, specifically mandated by the RRC. Although access to information, both printed and digital, is required, it is not mandated that this be provided by the department. (See Schwartz 9th ed., p. 5.)

3. Lawsuits and sentinel events most often are the result of

A. Inadequate medical knowledge

B. Substandard patient care

C. Poor interpersonal and communication skills

D. Unprofessional behavior

Answer: C

Studies reveal that physicians with good communication and interpersonal skills have improved patient outcomes and are subject to less medical litigation. In support of this, a root cause analysis by the Joint Commission identified breakdown in communication as the leading cause of wrong-site operations and other sentinel events. (See Schwartz 9th ed., p. 8.)

4. Which of the following is one of the three principles of the ACS Code of Professional Conduct?

A. Dedication to the patient’s welfare, independent of administrative forces

B. Reasonable reimbursement for testifying as an expert witness

C. Accepting patients, regardless of ability to pay

D. Referring patients to other doctors when conflicts do not allow the surgeon to continue to care for the patient

Answer: A

The ACS endorsed the Charter of Medical Professionalism as its Code of Professional Conduct in 2002. This model of professionalism is based on three principles. First, the physician should be dedicated to the patient’s welfare. This should supersede all financial, societal, and administrative forces. Second, the physician should have respect for the patient’s autonomy. This entails being honest and providing the patient with all the necessary information to make an informed decision. Third, the medical profession should promote justice in the health care system by removing discrimination due to any societal barriers. (See Schwartz 9th ed., p. 9.)


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