Subinternship
Goals and objectives for Sub-Internships
Sub-Internships provide the student with experience and preparation for inpatient medical care, similar to that of a
first year house officer and can be done in Medicine, Surgery, Pediatrics, Family Medicine, or Obstetrics and
Gynecology. When students are performing their Sub-Internship, regardless of department, they should act in all
capacities as an intern, albeit with a smaller number of patients and greater supervision.
The goals of the sub-internship are for students to:
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Be the "first evaluator" of patients
Perform complete history and physical examinations on new admissions
Independently establish a differential diagnosis
Write admitting and daily patient diagnostic and therapeutic orders, under the supervision of a resident and/or
attending physician
Evaluate patients on a daily basis on morning rounds, and serve as the principle care giver, under the direct
supervision of a resident and attending physician
Students can fulfill the requirement to complete their sub-internship at any of the major Tulane affiliated hospitals or at
another Academic Health Center with prior approval from the Office of Student Affairs. Students cannot complete this
requirement at a community hospital except in Family Medicine.
Because of the responsibilities involved in patient care, students are expected to provide appropriate care for patients, even
on designated school holidays (e.g. July 4th, Martin Luther King Day, Mardi Gras, etc.). Sub-Internships should not be taken
during months in which the student is interviewing extensively for residency positions. Students who are present fewer than
twenty (20) days will be required to make up the time missed during these excused absences. The student will not receive a
grade for the sub-internship until this time is made up. The amount and timing of the make up will be at the discretion of the
attending staff and the clerkship office. All anticipated absences must be cleared with the attending physician prior to the
rotation.
Four-Week
Electives for
the Clinical
Continuum
Note To Tulane Seniors Regarding Extramural Clerkships In General Surgery
Tulane students interested in applying for special surgical clerkships at other schools (extramurals) should note our medical
school's requirements for extramural clerkships stated on pages v., vi. and vii. of the Tulane senior's version of this brochure
and the additional requirements of the Tulane School of Medicine, Department of Surgery, which specifies:
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Only students who have had an excellent performance in their scholastic studies to date will be given approval for
such special clerkships.
Extramural clerkships must be shown to provide exposure in special interest areas, which might not otherwise be
available at Tulane University School of Medicine.
With regard to the Medical School requirement that the clerkship must be served in an institution which is an integral
part of a medical school teaching program, it must be emphasized that preceptorships will not be approved.
Credit will be given for one month of clerkship.
The Chairman of the Department of Surgery, or his designated representative, reserve the prerogative to
communicate personally with the designated Program Director and to solicit a grade for the student's work.
Pediatric Cardiothoracic Surgery
(Course Code: MDSR CT TMC)
Clinical clerkship with emphasis on operative experience and post-operative management of patients with congenital heart
defects
1 month rotation on the Pediatric Cardiothoracic Surgery service. Time will be Divided between the Cardiothoracic Surgical
Research Lab (10-20%) and the clinical service (70-80%).
Clinical (4 days/week):
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Morning multi-disciplinary rounds in the Pediatric ICU with members of Pediatric Cardiology, Pediatric Cardiac
Surgery, and Pediatric Intensive Care.
Four days a week spent in the ICU and operating room. Time will be divided between demonstrations of anatomy by
direct observation and review of diagnostic studies such as echocardiography and cardiac catheterization.
Explanation of treatment of congenital heart disease.
Attend weekly Department of Surgery grand rounds.
Attend weekly interdisciplinary cardiac catheterization conference
Pre and post-operative evaluation of patients
Laboratory (1 day/week):
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Participate in large animal experimentation including surgical preparation, data gathering, and data analysis.
Critical literature and statistical analysis.
Introduction to writing animal protocols and grants.
Objectives: Participation on the pediatric cardiac surgery service will serve as a model to demonstrate the interaction
between anatomy, physiology, and pharmacology in the care of patients with congenital heart lesions. The elective will also
integrate basic science research with clinical education at an introductory level.
Understand the anatomy & physiology of common congenital heart defects. Participate in the surgical repair and understand
the unique aspects of post-operative care.
Outline:
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A.M. Rounds With Attending
Operating Room-Scrub For Cases
P.M. Attending Rounds
Cardiac Cath Conference Weekly
Optional participation in clinical & laboratory research
Faculty: Thomas Yeh, Jr., M.D., Jamie Dorotan, M.D.
Pediatric and Congenital Cardiac Surgery
Time Offered: throughout the year
Method of Evaluating Student Performance: Daily interaction; 8 minute presentation on topic on student’s choice.
Presentation can discuss any aspect of the clinical or research aspects of the rotation.
How is this course evaluated by the Course Director: 1. knowledge of anatomy & physiology at end of course; 2. participation
in pt. care during course
How is this course evaluated by students: standard course evaluation
Prerequisite: 4th year elective
Plastic Surgery Clerkship: Tulane Medical Center
(Course Code: MDSR PLS C/T)
Students will serve for 1 month under the direction of the resident in Plastic Surgery and the attending staffs of Plastic
Surgery. Ward rounds will be made with the resident daily and with the visiting staff. The student will scrub on as many
patients as possible. The student will also attend Plastic Surgery Clinics and participate in the Plastic Surgery teaching
conferences.
Quota: 1 student
Duration: 1 month
Faculty: Dr. Ernie Chiu
Plastic Surgery Clerkship: OLOL (Baton Rouge)
Our Lady of the Lake Regional Medical Center
Our Lady of the Lake Regional Medical Center is the dominant institution in healthcare in the Greater Baton Rouge area. It is
also the largest private medical center in Louisiana, with 763 licensed beds. Opened in 1923, the Lake has grown from its
modest beginning to a major player in healthcare, with an outreach spanning geographical and political boundaries. In a
given year, Our Lady of the Lake treats approximately 25,000 patients in the hospital, and serves about 350,000 persons
through outpatient locations with the assistance of almost 900 physicians and 3,000 staff members.
Established in 1923 by the Franciscan Missionaries of Our Lady, the Lake continues to set the standard for quality patient
care.
Faculty:
Jonathan L. Kaplan, MD, MPH
Assistant Clinical Professor
Fellowship: Cleveland Clinic Foundation, Cleveland, OH
Residency: LSU General Surgery
Benjamin J. Boudreaux, MD
Assistant Clinical Professor
Fellowship: Cleveland Clinic Foundation, Cleveland, OH
Residency: UT Memphis General Surgery
Lucius Doucet, MD
Our Lady of the Lake Regional Medical Center
Plastics: UC-Davis
American Board of Plastic Surgery
Length of Rotation: 4 weeks
GOALS, OBJECTIVES AND EXPECTATIONS
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After completion of this rotation, the student will have touched on the core aspects of this broad field.
Basic knowledge of wound care
Participation in surgery
Participation in the Resident’s Clinic with staff supervision
Familiarity with different hands-on techniques such as suturing and dressing changes
Rounding with fellows on in-house patients
AREAS OF EXPOSURE:
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Facial Trauma
Trunk and Breast Reconstruction
Lower Extremity Reconstruction
Burns
Microsurgery
Flaps and Grafts
Wound Care
Anesthesia and Critical Care
Practice Management
SUGGESTED TEXTBOOKS

Grabb and Smith’s: Plastic Surgery
Breast Surgery Clerkship: Tulane Medical Center
(Course Code: MDSR ONC TMC)
The breast surgery externship is designed to provide additional experience in the management of breast cancer patients with
emphasis on surgery, and the multi-disciplinary approach in treating these patients. Special instruction directed towards the
diagnosis and treatment of all modalities is provided.
Quota: 1 student
Duration: 1 month
Faculty: Mary Jo Wright, MD
Surgery Research Fellowship - Tulane Medical Center
(Course Code: MDSR SRF TMC)
By special arrangement with Dr. Chip Bellows the student may integrate into one of several ongoing laboratory (benchwork)
research projects. The student will carry out, under direct supervision, experiments, collate and interpret subsequent data
and submit an abbreviated report summarizing these research efforts.
Objectives:
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To gain insight to the surgical perspectives on experimental design.
To develop technical skills relative to the selected experimental methodology.
To learn fundamentals in data interpretation.
Director: Faculty member of Department of Surgery
Quota: 1 student
Duration: 1 or 2 months
Prerequisite: Arrangements to be made well in advance by contacting faculty in Surgery.
Method of Evaluation: Faculty assessment of student's performance.
General Surgery Clerkship: Tulane Medical Center, Lakeside, or University (Course Code: MDSR SUB TMC; MDSR
SUB UH, MD SUB MCL)
Two students at TMC, one at Lakeside; one at University
NOTE: Tulane students may take this course for Core or Selective credit.
Students will serve as acting interns on the General Surgery service. As such, they will become an integral part of the
Surgery housestaff members assigned to the Tulane Medical Center. Students are expected to conduct daily ward rounds,
participate in surgical procedures, perform patient workups, and attend the Surgery Conferences. Students will follow the
daily routine of surgical houseofficers.
Objectives:
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Develop skills in diagnosis and management of surgical disease states;
Improve procedural skills (surgical techniques).
Faculty: Drs. Duchesne, Florman, Slakey, Weaver, McGinness, Bellows, Brown.
Quota: Two students at TMC; one at Lakeside; one at University
Duration: 1 month
Time Offered: All blocks (Blocks 01-10)
Method of Evaluation: Faculty completes an assessment form of student's performance.
Honors General Surgery Clerkship - Tulane Medical School
(Course Code: MDSR ADV TMS)
The students will be exposed to the responsibilities of an academic General Surgeon, as they pertain to teaching, research,
and service. The students will in part be responsible for the instruction of the principles of Surgery given to third year medical
students at the beginning of the General Surgery Clerkship. Each student will, under the direct supervision of one of the
faculty in the Department of Surgery, conduct a clinical or benchwork research project -- the results of which will be presented
to the Chairman of the rotation. Finally, the students will be instructed in basic surgical skills and techniques, both open and
laparoscopic, under the direct supervision of the General Surgery faculty. These skills will be refined in anesthetized pigs.
Objectives: Sharpen the skills of senior medical students committed to a career in General Surgery.
Director: Michael Weaver, MD
Quota: Minimum of 4 students, maximum of 10 students.
Time Offered: FIRST BLOCK ONLY, JULY.
Duration: 1 month
Prerequisite:
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A grade of "Pass" or higher during the third year clerkship.
Committed to pursuing a career in General Surgery.
Direct approval must be obtained from Dr. Michael Weaver & Dr. James Korndorffer
Student Evaluation:
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Surgical skills will be evaluated in the animal laboratory.
Manuscript will be graded by the Chairman of the Department of Surgery.
Course Evaluation: Direct feedback at a meeting between students and faculty participants conducted at the end of the
course.
Pediatric Surgical Clerkship: Tulane Medical Center
(Course Code: MDSR PED TMC)
Students will be expected to be an active member of the surgical team. A variety of interesting and complicated cases will be
seen during any one clerkship period. The students are urged to act with the house staff in the preoperative evaluation, the
operative and postoperative care of the Pediatric patient. They will be expected to scrub in on all operations.
Faculty: Dr. Rodney Steiner
Quota: 1 student
Duration: 1 month
Surgical Critical Care: Tulane Medical Center or University
(Course Code: MDSR ICU TMC)
This one month rotation will be situated in the Tulane Medical Center Surgical Intensive Care Unit (or UA). It is designed to
give the student a broad experience in Surgical Critical Care. The student will be an integral part of the Surgical ICU team
and will participate in ICU rounds, educational sessions, conferences, and procedures.
Objectives: To acquaint the student with Surgical Critical Care with emphasis on such topics as shock, invasive monitoring,
ventilator management, nutrition, surgical infectious diseases, and pharmacology.
Director: Juan Duchesne, M.D.
Quota: 2 students
Duration: 1 month
Method of Evaluation: Students will be evaluated as to their performance on rounds, during small group discussions and their
presentations. All of the ICU attendings will have input into the evaluation. The evaluation will be written and utilize the same
form as the junior general surgery clerkship.
Every 6 months, the Course Director will review the comments solicited from the participating students and ICU faculty. At
the completion of each rotation, the student will meet with Course Director at which time the student's evaluation of the
course will be solicited. Additionally, each student will be asked to complete a written evaluation of the course.
Prerequisite: Successful completion of Junior General Surgery clerkship.
Senior Surgery Selective: Centreville, Mississippi
(Course Code: MDSR GEN CEN)
The student will be on a one-on-one basis with Dr. Richard Field throughout his stay in which he will make rounds twice a day
and operate daily. He will serve as first assistant the majority of the time and second assistant the remainder. He will work in
the outpatient clinic with Dr. Field in the afternoon and will attend the Journal Club on Friday mornings and the monthly staff
meeting of the hospital.
Quota: l student
Duration: 1 month
Time Offered: Blocks 02, 04, 06, 08, and 10
Note: This course is also offered for Community Medicine Core Credit (Course Code: MDCM CMQ CEN) in alternate
blocks: 01, 03, 05, 07, 09. If an opening is available, this course may be taken as a Surgery Selective using the code MDSR
GEN CEN.