Surgical Residency Program

Program Instructor Hiroaki Terashima

1. Program objectives and features

Students aim to acquire basic knowledge and skills by utilizing the knowledge gained in the mandatory training in the first year.

1. In the surgical ward, specialized groups rotate every two months to build up basic knowledge about problems in each of the more specialized fields.
2. The speciality groups are as follows:
• (1) Upper gastrointestinal tract group
  ⇒Treatment strategies for esophageal and gastric cancer
• (2) Lower gastrointestinal tract group
  ⇒ Treatment strategies for colon cancer and rectal cancer, endoscopic and laparoscopic surgery
• (3) Hepato-Biliary-Pancreatic Group
  ⇒Towards multimodelity therapy

* Each group will hold a "pre- and post-operative case review meeting" once a week to deepen their understanding of treatment plans. In addition, by considering the post-operative course, they will hold thorough group discussions about the next line of treatment (2nd line), linking this to the practice of gastrointestinal cancer treatment.

2. Training and guidance system and basic goals

1. As a rule, surgical instruction is provided by a medical instructor from the Japanese Society of Gastroenterological Surgery. Students will gain a deeper understanding of basic organ-specific treatment in accordance with the guidelines.
2. The goal is to become a surgeon for appendicitis surgery, hernia surgery, laparoscopic surgery, cholecystectomy, etc.
3. The aim is to thoroughly master basic procedures (incision, suturing, drainage procedures, etc.) and acquire patient management skills with an emphasis on postoperative care.
4. Consider writing a case report paper, including presentations at various academic conferences.
5. Deepen your understanding of how to read papers and EBM.

3. Goal to reach

1. Overview...The training goal is to cover six months of the second year (gastroenterological surgery only), taking into account two months of the first year.
2. Specific goals
• (1) Team medical care
• They will participate in medical care in a collaborative manner as part of a medical team consisting of doctors, nurses, physical therapists, etc.
• Consult with supervising physicians and specialists as appropriate and as needed.
• Interact appropriately with superiors, colleagues and other healthcare professionals.
• (2) Medical interview and medical history
• Take and record the patient's medical history.
• Understand what informed consent is and provide appropriate guidance and instructions to patients and their families.
• (3) Document Records
• Prepares documentation regarding the patient's overall care.
• Medical records are recorded and managed in accordance with the POS (Problem Oriented System).
• Accurately complete and maintain prescriptions, daily procedures, and test orders.
• Create and manage referrals and referral responses.
• (4) Safety management and medical risk management
• Understand safety management and medical risks in the medical field to ensure patient safety.
• Act in accordance with manuals and other documents regarding the prevention of medical accidents and how to deal with them after an accident occurs.
• Understand and implement hospital infection control measures.
• (5) Preoperative management
• Have knowledge and practice regarding preoperative physical management (especially cardiopulmonary management), continuation and discontinuation of drug administration, etc.
• Have knowledge and practice of nutritional management (dietary therapy, enteral nutrition, total parenteral nutrition) and fluid management.
• Prescribe antibiotics, anticancer drugs, etc. with thorough knowledge of their indications, contraindications, and administration methods.
• List and instruct necessary preoperative treatments depending on the disease, such as laxatives and IVH.
• We perform procedures such as inserting a gastric tube, catheterizing, and administering enemas.
• Properly complete anesthesiology request forms and exchange information with anesthesiologists.
• (6) Participation in surgical treatment
• Understand and implement local anesthesia methods and types of anesthetics.
• Understand the anatomy necessary for abdominal surgery and understand surgical procedures.
• Understand and use the instruments required for surgery.
• Understand the concepts of surgery for digestive cancer and provide appropriate assistance.
• (7) Postoperative management
• Abnormal conditions in the circulatory and respiratory systems during the acute postoperative period are quickly identified through a comprehensive assessment of physical findings, various monitor indicators, blood gas analysis, and hematological and biochemical tests. Abnormal conditions are also dealt with promptly through drug therapy and surgical procedures.
• Change the gauze and bandages, and observe the drain contents and determine their condition.
• Understand and implement the principles of suture removal.

Medical rounds

1. Daily activities