• Welcome
• Clerkship Expectations
  • Patient Assignments
  • Kinds of Workups
  • Call
  • Outpatient Clinic
  • Operating Room
  • Conferences
  • Evaluation Process
  • Grade Review Process
• Overview
  • Goals
  • Infection Control
  • Protected Time
  • Illnesses/Absences
  • Dress Code
  • Priority List
• Core Curriculum Conferences
  • Acute Abdomen & Hernias
  • Anorectal Disease
  • Breast Disease
  • Colorectal Disease
  • ENT I
  • ENT II
  • Gall Bladder
  • Heart Disease
  • Jaundice & GI Bleed
  • Lung Disease
  • Ortho I
  • Ortho II
  • Pediatric Surgery
  • Perioperative Care
  • Plastics I
  • Plastics II
  • Sepsis Mgt. & ICU
  • Trauma
  • Urology I
  • Urology II
  • Vascular I
  • Vascular II
  • Woundcare
• Specialty Descriptions
  • Cardiothoracic
  • Colorectal
  • Emergency Medicine
  • General Surgery
  • Neurosurgery
  • Orthopaedics
  • Otolaryngology
  • Pediatrics
  • Plastic Surgery
  • Trauma
  • Urology
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• Current Clerkship
  • Call Schedule
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  • Orientation Schedule
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Expectations

GOAL:
The major goal of the surgery clerkship is to assure that all students acquire the skills and knowledge that all physicians need to know in order to manage patients with a number of conditions commonly treated by surgeons.

DESCRIPTION OF THE CURRICULUM:                   
The clerkship is ten weeks long. The first two days of the rotation will be devoted to overall orientation to the clerkship and in the final week two days of the rotation will be devoted to evaluation. Of the remaining weeks, you will spend two weeks with a general surgical team and one week on the colorectal service. During this time you will participate actively as a member of the team, under the direction of a Chief Surgical Resident. You will also spend one week on the Critical Care/Trauma Service where you will have an opportunity to participate in the care of injured and critically ill patients. You will then be able to select from several one-week options to complete the surgery clerkship. For this period you will participate on surgical subspecialty services. Options include ENT, Vascular, Cardiothoracic, Orthopedics, Plastic Surgery, Urology, Neurosurgery and Pediatric Surgery.
During the clerkship, students will not spend on average more than eighty hours per week in required clinical and educational activities. Required activities include, but are not limited to, interactive core teaching conferences, hospital rounds and activities, out-patient clinic attendance, in-house and at home call, and attendance at examinations. Required activities do not include personal study time or optional educational experiences.

OBJECTIVES:
At the conclusion of this rotation, all students should be able to:

1. Demonstrate an adequate knowledge of surgical diseases by passing the NBME Surgical Shelf Examination.
2. Demonstrate adequate clinical reasoning by successfully passing the Standardized Patient Examination.
3. Display professional behavior and function effectively as a member of a health care team.

PATIENT ASSIGNMENTS:
You will be given daily patients assignments to a total of a minimum of 25 “different” patient cases for the clerkship. A minimum of 10 cases (of the 25) will be inpatients and 15 (of the 25) will be outpatients. You will be assigned cases up to the end of the clerkship. This means that you will be assigned to more than the minimum 25 cases.
The team you are working with will make your clinical assignments. You are expected to be prepared for each surgery and clinic. If you are not prepared you can expect to be asked to leave. After completing the surgery or clinic you must record the case information on the PDA logbook online form within 72 hours. Any patient activity logged after the deadline will not be accepted. Please note that at the top of the online form you must choose whether or not the patient encounter meets the requirements as one of the 25 required cases.
Each student is expected to attend rounds with the residents every morning and evening unless you are participating in core curriculum, mentor rounds, or assigned OR clinic activities.
Students, while in the Surgery clerkship will follow the holiday schedule according to institutional policy. This means that on school holidays, students are not required to assume clerkship-related responsibilities.
You will receive a weekly schedule that includes all mandatory conferences, pre-scheduled clinics, mentor rounds, and core curriculum sessions. Please keep in mind that the schedule is subject to change. We will make every effort to contact all of you as soon as we are made aware of any changes to your schedule.

KINDS OF WORKUPS AND WHEN TO USE THEM:

INPATIENTS (Patient in house night before surgery) A.M. ADMISSION (patient admitted the morning of their scheduled surgery).All patients remaining in hospital for a minimum of two postoperative days will count towards the required inpatient assignments. You are not allowed to make patient rounds prior to 5:00 AM. Ideally your daily progress notes should be on the chart prior to the resident’s notes. If you find that you don’t have adequate time to see all of your patients before morning rounds and or your patient assignment seems to be too heavy please contact the nurse educators or the chief resident on the service.
Responsibilities include:

Assess patient preoperatively when possible but must review H&P

1. Participate in the surgery
2. Assess patient four to six hours postoperatively
3. Daily progress notes
4. ICU and IMC patients must be seen both in the morning and evening.
5. ICU and IMC status determined by orders written on chart.
6. Patient rounds will be completed every day (including Saturday morning) except for Sunday.
7. If during your rounds you have a question about one of your patients, page the resident involved in the case and discuss it with him/her. If the resident instructs you to write a new order, the order must be co-signed by the resident or attending before the nurses can carry it out.  If the nurse is close by the phone, she can take a verbal order from the resident or attending.  If not, the order will not be initiated until after it has been co-signed.
8. All patients must be followed until discharge or until you leave the service.
9. SAME DAY OUTPATIENT (patient admitted for less than 24 hours)

This patient is counted as one of your required outpatients.

Assess patient preoperatively when possible but must review H&P

1. Participate in the surgery
2. Assess patient four to six hours postoperatively
3. Assess patient and write progress note in AM prior to discharge.

3.  OUTPATIENTS (patients discharged day of surgery)

Responsibilities include:

Assess patient preoperatively when possible but must review H&P

1. Participate in surgery.

SUMMARY PATIENT ASSIGNMENTS

*Inpatient counts only if patient remains in the hospital 2 days post-op. Otherwise a same day outpatient counts as an outpatient.

CALL:

General, Ortho and Critical Care/Trauma call are all a 24-hour IN-HOUSE experience. During call experiences the student responds to and participates in patient care on the wards, trauma, emergency surgery and emergency admissions referred to the surgical services. All other surgical areas will determine specific requirements for call.  Coverage of weekends is required. If you are unable to take call on your scheduled night, it is your responsibility to find a replacement. 
General and Trauma call will be pre-assigned by the clerkship. All assigned call time is the student’s responsibility. Any changes to the call schedule must be approved by a nurse educator. The student may go home at noon following an in-house call night. However, you must return for core session as it is mandatory at all times and we cannot grant time off even if you had to participate in patient care activities all night. You must get your pocket handbook signed and dated by the resident you were with on call. These will be checked by the nurse educators.

OUTPATIENT CLINICS:
You will be assigned to various clinics throughout the clerkship. During your general and colorectal rotations you will be assigned by the clerkship coordinator to clinics. These will include General, Colorectal, Vascular, Otolaryngology, Ortho and Breast. Make sure that you check the clinic calendars located in each student lounge for the specific nature of the clinic you will be attending. Colorectal, Vascular, Musculoskeletal, Otolaryngology and Breast all have mandatory clinic modules you must view on Blackboard prior to participating in the clinic. The clinic modules contain multiple choice questions that must be answered correctly at the end of each module. The faculty have developed these modules to help you prepare for the clinic experience therefore if you are not prepared for your clinic you can expect to be asked to leave. All clinic activities must be recorded on the PDA logbook online form.
It is important to be on time.  If you must be late for a clinic it is a good idea to call ahead to let the physician and his staff know. Office phone numbers and clinic locations are listed in your student room and pocket handbooks.  It is the student's responsibility to check out the location prior to the clinic day.

OPERATING ROOM:

It is recommended that you do not have valuable items/money with you in the OR Department.
The time before surgery is best spent helping to prep the patient.  This is a good time to practice bladder catheterization, IV's and NG insertions (ask the circulating nurse if you may do these procedures).
Scrub suits are NOT to be worn out of the Surgery Department.  If you must leave the OR, change back into your street clothes.  If you are leaving the Surgery Department for a short period and plan on returning for a case, put a long cover jacket over your scrub suit and then CHANGE INTO A NEW SCRUB SUIT before going back to the operating room.  The OR staff reserves the right to correct your surgical or sterile technique if necessary as it is their responsibility that correct technique be maintained in the Surgery Department.

INFECTION CONTROL: See Pocket Handbook
This is the clerkship with the most opportunity for a needle stick or body fluid exposures. Be sure to review the information available in your pocket handbook.

CORE CURRICULUM SESSIONS:

Core curriculum sessions will be held at a minimum of twice a week and will consist of faculty directed discussions that will focus on actual patient case scenarios. These sessions will encompass all specialty areas and will focus on cases commonly seen in a primary care practice.  These sessions are mandatory and will supersede all other activities. You must prepare in advance for these sessions by reviewing the specific objectives, reading the suggested readings and cases to be presented. You will be evaluated by each faculty member in regards to your participation and evidence of your level of preparedness.

Surgeons and Professionalism
There will be one session devoted to discussing the issues that surround surgeons as professionals. You will be asked to submit a short essay based on your personal observations of surgeons during the surgery clerkship. You will receive full credit for simply submitting the essay and your responses will be kept anonymous. You should submit your responses by the end of the 6th week of the clerkship to Jessica Davis. She can record that you submitted the responses without you having to put your name on your paper. Some responses will be discussed during the session on professionalism but the identity of the authors will not be disclosed.
Use the following three questions to write your essay.

1. Describe an instance where a surgeon or surgery resident did something that you believe is a positive example of professionalism.
2. Describe an instance where a surgeon or surgery resident did something that you believe was unprofessional behavior.
3. How has your experience in the surgery clerkship changed your ideas about professionalism?

SIMULATION SESSIONS
There will be several simulation sessions provided during the clerkship. These sessions will provide experience with the human patient simulator called I-Stan. This is a computerized full body mannequin that is able to provide real-time physiological and pharmacological parameters of persons of varying ages with different health conditions. These sessions will be interactive and will be solely for educational purposes. These sessions will not be evaluated but will provide opportunities to practice patient assessment and management while having faculty present to provide immediate feedback and guidance.
There will be a total of 3 sessions. Two of the sessions will involve Trauma resuscitation and will be done in a large group. One session will be done in small groups of 4-5 students and will cover common post operative complications. Each student will have an opportunity during this session to have individual experience with running a simulation.

PROTECTED STUDY TIME:
Protected time has been designed to guarantee a minimum amount of study time for the students. Protected time begins on Monday and Wednesday at 6:00 pm and all day Sunday. The exception is as follows: students on call on Saturday will start protected time after rounding on Sunday morning with the team.

CONFERENCES:

M&M (Morbidity & Mortality) is held every Thursday morning from 0700-0800 at MMC. Grand Rounds, held every other Thursday*, immediately follow the M&M conference.  Attendance is required at M&M and Grand Rounds for students in General, Colorectal or Trauma. While rotating on any other service you should follow their conference calendar. *No Grand Rounds during July *
While on the general and colorectal service you will attend the Monday morning (0700)

Attending rounds with your designated team. Each individual team will discuss the weeks patients with the faculty involved. Sites for the attending rounds are as follows:                          

Monday Morning Attending Rounds:
Colorectal Service                                     D0005 at MMC
General Service                                          Hunt Board Room at MMC

*No Grand Rounds during July *

Some specialty services require student to attend their morning conferences. Exceptions to conference attendance will be given on an individual basis.

EVALUATIONS:

1. National Board of Medical Examiners (NBME) Surgery Subtest Examination. This MCQ type examination is given at the end of the clerkship. We expect that a score of 75 or greater will be consistent with an exceptional level performance and a score of 60 or greater will be consistent with a satisfactory or passing performance. Performance on this examination is used to assess Knowledge and Clinical Reasoning.

1. Standardized Patient Examination. This is an examination designed to test the skills and knowledge that have been taught as part of the course. An exceptional performance is consistent with a score above the mean and a satisfactory performance is consistent with scoring no lower than two standard deviations below the mean. The mean score has been determined from the accumulation of all test scores for each individual case. In order to pass the clerkship in a satisfactory manner you must pass this exam. If you fail to meet the minimum requirements your case will be brought before the Surgical Educational Performance Group. Remediation for this failure will be determined on an individual basis and could result in repeating the standardized patient exam.

Cases for this exam will be chosen from the following common surgical patient presentations: abdominal pain, colorectal disease, breast disease, hepatobiliary disease, hernia, trauma.

1. Performance evaluations of student professional behaviors and clinical reasoning. These evaluations are distributed to faculty and residents with whom the student works during the course of the clerkship. An average score of 7.3 in the area of clinical performance and an average score of 7.75 in the area of non-cognitive performance is consistent with an exceptional level of performance. An average score < 6.2 in the area of clinical performance or an average score of < 6.5 in the area of professional behavior is consistent with failing those portions of the overall clerkship evaluation. These evaluations are used to assess Clinical Performance and Noncognitive Behaviors. If you fail to meet the minimum requirements your case will be brought before the Surgical Educational Performance Group. Remediation for this failure will be determined on an individual basis and could result in repeating the entire clerkship.

1. Preparation for core sessions will be evaluated. Faculty will assess your level of participation and preparedness as either a +1 (very well prepared) or a -1 (not prepared). If you receive > 4 negative evaluations you will not be eligible for receiving an Honors rating. In addition, if you have an overall negative score for preparedness your case will be brought before the Surgical Educational Performance Group. Remediation for this failure will be determined on an individual basis and could result in failure and required to repeat the entire clerkship.

Honors is achievable by receiving an exceptional evaluation in all three areas of the medical school official final clerkship evaluation.

Minimum Passing Requirements

EVALUATION PROCESS:

Midterm evaluations are provided by the Nurse Instructors at the mid point of the clerkship. This will include your average team evaluation scores, preparation scores, current number of peri-operative reports and current inpatient and outpatient activity that has been appropriately submitted to your log book.
Once all of the examination scores are available, the nurse instructors and clerkship director review the entire student portfolio, discuss the student’s performance and recommend a final grade for the student. The Student Progress Committee of the Department of Surgery reviews this recommendation and a final grade is assigned.

Access to Evaluation Material

Team evaluations are anonymous until the completion of the clerkship. A grade is not final until the Student Progress Committee of the Department of Surgery assigns it. No information will be given to students about the final grade until this committee has concluded its deliberation. Any information that the student might receive from any source regarding the final grade should be viewed as preliminary. The student may review all of the evaluation material once the grades have been turned into The Office of Student Affairs. The student must make an appointment with one of the nurse instructors or clerkship coordinator to view their individual evaluations.

Clinical Clerkship Grade Review Process
All students shall be entitled to ask for a review of a final clerkship or segment grade by the department and receive a timely response. All departments shall be required to substantially comply with the following guidelines.
When the final grade for the clerkship is assigned, students will receive e-mail notification from the department that the evaluations are complete and have been sent to the Office of Student Affairs. Students will receive a second email notice when the final evaluations have been officially recorded; this notification will include a reminder of the Grade Review Policy.
If a student believes that there has been an error in the grading process, or believes that the final evaluation does not accurately reflect the performance, the student may speak informally with the faculty to find a resolution; however the student is not required to pursue an informal review if s/he chooses. S/he may request a formal review. To begin the formal review process, a student must provide the Clerkship Director with written document that outlines the basis for the request. Unless there are unusual or compelling circumstances, the written request, along with any supporting documentation, must be filed by the student within six weeks of the date formal notice is sent advising the student that final evaluations have been officially recorded and available for review in the Office of Student Affairs. The request for review will prompt a review of the student’s portfolio. The outcome of this review will be shared with the student before any change in evaluation is submitted to the Office of Student Affairs. The Clerkship Director, in writing, must respond to the student’s request within two weeks of receipt of the request for review.
Should the student wish to have further review of the Clerkship Director’s decision, a written request for grade review will be submitted to the Chair of the Department within two weeks of the decision of the Clerkship Director. The Chair of the Department must respond, in writing, to the request for review within two weeks of receipt of the request for review. The decision of the Chair of the Department will be submitted as the final grade.

ILLNESS AND OFF-CAMPUS ABSENCES:

If you are ill, you must page the senior resident on your team no later that 7:00 a.m. An email to a member of the team is unacceptable. You must also notify the nurse instructor. Failure to notify all of the proper individuals will be considered unexcused and will be reflected on the end of clerkship final evaluation. The Clerkship Director and Dean of Students will be notified if any student is absent. Off-campus absences (due to family illness, official school events, etc.) must be approved in advance. Be sure to inform the Nurse Instructor so she can make the appropriate changes in your schedules. The expectation is that students will have 100% attendance. All time must be accounted for and all absences, except official school functions, will be made up by the student. This may require extra weekend coverage and/or additional clinical time after the clerkship is completed.

DRESS CODE:

Appropriate attire must be worn during school activities.  This includes all clerkship responsibilities such as conferences, patient visits, Core Curriculum, etc.  Lab coats must be worn during all patient encounters. Open toe shoes are not acceptable.
Scrubs may not be worn outside the operating room suites except by the student on overnight call, and then only after 5:00 PM. Scrubs may be worn by students on the trauma service, however you must change into street clothes prior to Mentor sessions, Core, X-ray, M&M conferences, and Grand Rounds. Students are not allowed to wear scrubs during patient rounds on the weekend.

PRIORITY LIST:

This clerkship is complex due to the fact that you are participating in a wide variety of activities. It is important for you to understand what are considered to be the priorities in order to avoid difficulty in dealing with conflicting activities. The order of priorities is as follows:

1. Core Conferences
2. Assigned clerkship activities
3. Patient care
4. Revised 6/9/09

Student’s Name           _________________________               

Evaluator                                                                                

Date(s) of Contact           ____________________________                                                  

Extent of Contact (Check One)

1. NO CONTACT.
2. Limited- student participated in one or two cases.
3. Moderate- student participated in a few cases and/or limited other clinical care activities.
4. Substantial- student participated in many cases and/or other clinical care activities.
5. Extensive- student participated in many cases, and/or other clinical care activities over a prolonged period of time.

Please provide a rating for each category that you feel comfortable evaluating. Narrative comments that identify specific student behaviors are extremely valuable.