Surgery A Student Responsibilities
1. A. Lecture takes precedent over other clinical activities.
B. Students’ primary clinical responsibilities in any given week are related to those of
their assigned attending.
Surgery A Attending Schedules
Monday
Calvo
Gallagher
Hboro (8-12)
CH (1:00-4)
CH (8:00-2)
OR
Tuesday
OR
OR
Wednesday
OR
CH (10:30-3)
Thursday
OR
Friday
CH (8-5)
OR
Hboro (1:00-5)
OR
HJ Kim
CH (8:00-3)
Hboro (8:00-3)
L Kim
OR
CH (10:00-1:00)
OR
CH (1:00-3:30)
Meyers
OR
Hboro (11-3)
CH (10:30-3)
OR
Ollila
Hboro (1-4)
OR
CH (8-12)
OR
Stitzenberg
CH (8-11:30)
OR
Yeh
CH = North Carolina Cancer Hospital Clinic (2nd Floor) Hboro = Hillsborough clinic
C. Whenever in doubt about what to do, refer to 1A and 1B.
2. Formal History and Physical Write-ups.
Each student should turn in three formal write-ups to the assigned attending. The first of these should be
completed and turned in prior to the completion of the second week on Service to allow for feedback to
be applied to the remainder of the write-ups.
3. Inpatient Care
A. Morning Rounds: Students will be expected to make rounds on their patients and present a
concise summary of overnight events. These are work rounds and there should not be the
expectation of extensive teaching on rounds.
B. Progress Notes: Daily notes should be completed in SOAP format. These should be a concise
summary of events and the plan of care.
C. Inpatient H & P’s: Students will assist with inpatient H & P’s and transfer notes as needed. The
majority of these are now dictated, but you should be in communication with the junior residents on
the Service on a case-by-case basis.
D. Afternoon Rounds: Students will participate in afternoon rounds with the surgical team. These
will serve as the primary teaching rounds on the Service.
4. Outpatient Care
Students will participate in the evaluation of patients in the clinic as determined by the weekly clinic
schedule of the assigned attending.
5. Operative Care
Students are expected to attend and scrub into the cases performed by their assigned attending. If there
are simultaneous cases performed by another students’ assigned attending, students without any other
assigned duties should actively pursue opportunities to be involved in these cases.
LEARNING OBJECTIVES FOR SURGERY A
(GENERAL, ONCOLOGY, ENDOCRINE)
LEARNING OBJECTIVES
1. Upon completion of the Surgery A Rotation, each student should be knowledgeable in the
following surgically related problems:
A. Gastrointestinal Cancer -- Colorectal, esophageal, gastric, pancreatic carcinomas
B. Benign Breast Disease
C. Breast Cancer
D. Malignant Melanoma and Squamous Cell Carcinoma
E. Thyroid and Parathyroid Disorders
F. Gastrointestinal and Retroperitoneal Sarcomas
G. Anorectal Disease
H. Diseases of the Gallbladder and Biliary Tree
I. Appendicitis
J. Acute Abdomen
K. Pancreatitis
L. Intestinal Obstruction in Adults
M. Diverticulitis
N. Diseases of the spleen
While not frequently treated on Surgery A, students should also read about:
A. Hernias
B. Inflammatory Bowel Disease
C. Peptic Ulcer Disease
2. Each student will formally record the history and physical examination on each of their patient
admissions (3/student/rotation). Work-ups should include differential diagnosis and initial
diagnostic procedures. These should be submitted to the designated faculty advisor for review and
critique. Please resist the urge to wait for the ideal patient or the one who you are trying to follow
from admit to discharge. Pick any patient that you are following or operated on and interests you.
This will serve the purpose of this exercise.
3. Operating room experience is provided so that students are able to:
A. Learn proper scrubbing technique
B. Perform at the operating table using aseptic technique
C. Correlate pathological findings with signs and symptoms of disease in your patients
4. Refinement of technical skills is encouraged. Students should seek out opportunities to:
A. Perform venipuncture
B. Start IV’s
C. Place and remove NG tubes
D. Assist housestaff in surgical procedures such as cutdowns, thoracentesis, paracentesis,
placement of central lines, insertion and removal of Foley catheter, sigmoidoscopy and obtaining
arterial blood gases.
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SURGERY A ORGANIZATION
The Surgery A Service is one of the three services performing general surgical procedures at UNC
Hospitals. Surgery A specializes in oncologic and endocrine surgery. Surgery A is composed of three
separate units broken down by attending. Generally, one student will be assigned to a surgeon in a unit
for a two week period, and then switched to another unit.
Attending Surgeons: Drs. Benjamin Calvo, Nancy DeMore, Hong Jin Kim, Larry Kim, Michael Meyers,
David Ollila, Karyn Stitzenberg, Jen Jen Yeh and Colin Thomas, Fellows: Drs. Sonia Cader and
Nicholas Schaub.
Unit
GI 1
GI 2
Breast/Melanoma
Attending
Calvo/Yeh/Stitzenberg
HJ Kim/Meyers
Gallagher/Ollila/L Kim
Residents
Chief or Fellow/3nd year/Intern
Chief or Fellow/Intern
Chief or Fellow/Intern
All Surgical Oncology attending physicians can be reached in the Surgery Department at 966-5221.
Email addresses are:
calvo@med.unc.edu
kimhj@med.unc.edu
david_ollila@med.unc.edu
karyn_stitzenberg@med.unc.edu
nicole.lopez@unchealth.unc.edu
kristalyn_gallagher@med.unc.edu
mmeyers@med.unc.edu
jen_jen_yeh@med.unc.edu
lawrence_kim@med.unc.edu
nicholas_schaub@med.unc.edu
The Chief Residents are responsible for the organization and function of the Service. They supervise the
care of all patients on Surgery A. The housestaff and students are responsible to the Chief Resident.
Ultimate responsibility of all patients lies with the Attending Surgeon. The Chief Residents are on
continuous call for his/her patients. Night coverage is provided by both Senior and Junior Residents as
well as the First Year Residents. All are on call every third night requiring cross coverage between A,
GI, and H to provide adequate care, but organized so that each Service (A, GI, & H) has a ‘’Resident on
Call’’ every night. Night coverage is provided by the Junior Resident and the First Year Resident, who
remain in the hospital all night. The students should contact the resident with the consult beeper (second
year resident) and shadow that resident to all surgical consults. The student on call also assists the First
Year Resident at night until all work is done and is strongly encouraged to remain in the house.
After an orientation period, Acting Interns take call with the First Year Residents. Third year students
rotate call among themselves.
ON CALL
The Chief Resident on Surgery A will be responsible for coordinating the student On Call Schedule and
helping students divide new admissions and transfers for student work-up.
The Department of Surgery has no requirement for In-House Call for students rotating on the Surgery
Services. It is the belief of the Surgery A Service that the learning opportunities for students on call
occur through consultations which get called to the second year resident on the Service. These will
include consultations on hospital wards as well as through the Emergency Rooms. It is in the history,
physical and laboratory examination of these patients that the students are best equipped to learn rather
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than on arrival to the operating room. For these reasons, we believe that it is much more productive to
remain On-Call, In-House if possible.
There are sleeping facilities for the Surgery A Service on 4 Anderson North which will be made
available to both female and male students if they choose to take advantage of this opportunity. Again,
there is no requirement that students remain overnight on-call; however, it is impractical to believe that
coming from home for consultations in the middle of the night will occur with any regularity.
NEW ADMISSIONS AND TRANSFERS
A major source of learning is obtained from new admission and transfer work-ups. Students are to
obtain a complete history and perform a physical examination on all new admissions. Rotation and
patient assignments may be made by the students, but all patients must have a student work-up. New
patient work-ups should be equally divided both in number and in the types of disease. For example,
one student should not work up all of the patients with gallbladder disease, but should arrange with his
classmates an equitable distribution so that everyone may benefit by evaluating that particular disease.
On heavy admitting days, this will require that students work up patients in rotation, even though they
are not on call.
The history and physical examination should follow the SOAP format with special attention to the
pertinent positive and negative findings. The assessment and plans should be carefully considered with
justification presented by the student for his/her plan of therapy. If a student disagrees with the
housestaff on their approach to the problem, then he/she should recommend his/her plan of therapy and
not that of the housestaff’s. A concise discussion covering any interesting aspect of the problem should
be attached to the work-up.
Progress Notes
Progress Notes represent an excellent mechanism to stimulate the development of proper assessment and
plans for managing patient problems. The students should take an active role with the housestaff in
writing the Preoperative Note, Postoperative Note, and Progress Notes on their patients. The student
Progress Notes do not take the place of the housestaff and Attending notes. Each member of the
housestaff writes pertinent notes on all his/her patients. A Postoperative Note is always placed on the
chart the day or night prior to surgery. This contains the pertinent subjective and objective findings
related to the planned surgical procedure. Progress Notes are generally required on a daily basis
following surgery since the patient’s condition is under constant change. The initial Progress Note
following surgery is entitled the Postoperative Note. The Student Progress Note should follow the
format outlined:
Date
Time
POD
Student Progress Note:
Vital Signs
Subjective findings
Objective findings
Assessment and plans
The Student Progress Note must be concise and pertinent. Lab data is not recorded unless directly
related to a change in the patient’s clinical status. Assessment and plans should be discussed with a
physician before writing in the chart. Remember the chart is a legal record, and statements should show
responsible thinking. A minimum of one Student Progress Note every day until discharge is required.
The surgical housestaff and Attending physician countersign Student Progress Notes and add comments,
corrections and additions.
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OPERATING ROOM OPPORTUNITIES
Each student should have the gross pathology demonstrated to him/her in the operating room on all the
patients he/she is following (new admissions and transfers). The student is expected to scrub whenever
possible. All students are expected to have operating experience and be knowledgeable in operating
room conduct. The student does not have to participate in the entire operative procedure, but is
encouraged to do so whenever possible. It is the student’s responsibility to check on the time of the
operative procedure so that he/she may plan his/her activities to be present.
ROUNDS
Early morning Work Rounds are conducted by the Housestaff to determine any changes in each patient’s
condition and make decisions regarding management for the day. Rounds begin at the discretion of the
chief resident, but typically will start at 6:30am in the surgical ICU. Students are responsible for keeping
abreast of the clinical condition of their patients and decisions for management.
The Chief Resident supervises daily afternoon Teaching Rounds with the Housestaff and students.
Questions and discussion are encouraged. At periodic intervals, the Attending surgeon for the Service
participates in these afternoon rounds. Students are expected to be able to present a brief, concise
synopsis of the patient’s problem and progress on rounds.
ORDERS
Students are to learn to write postoperative orders. This is done under direct supervision of the
housestaff. Proper organization of orders is a high priority. Knowledge of the correct dosage of
medicine, proper laboratory tests, and nursing orders is necessary. Orders will be available in the
computerized order entry system such that students can write their own orders and then be countersigned
by housestaff.
CONFERENCES AND ROUNDS
There is an abundance of formal teaching sessions which meet on a regularly scheduled basis on Surgery
A. The student should attend as many of these sessions as possible. Below is the list of rounds and
conferences.
MONDAY:
6:30 AM – Rounds – Surgery ICU
07:30 AM -- Multidisciplinary Tumor Board Conference – CG222 NCCH
08:30 AM –Surg Onc Div M&M, 2nd Fl NCCH
01:00 PM -- Student Rds – Dr. Thomas - 4052 Burnett Womack Bldg.
04:00 PM – Ward Rounds- (Entire Surgical Oncology Service) – 7 Neurosciences
TUESDAY:
6:30 AM – Rounds – Surgery ICU
WEDNESDAY: 6:30 AM – Rounds – Surgery ICU
07:15 AM -- Surgery Grand Rounds -- Clinic Auditorium
8:00 AM -- Multidisciplinary Breast Conference -- CG222 NCCH
09:00 AM – Melanoma Conf. (2nd and 4th Weds.) – 3rd Fl. Pathology Classroom,
Women & Children’s Hospital.
04:00 PM – Conference with Dr. A. Meyer – Rm 4050 Burnett Womack
Includes Surgery A, Surgery GI/T, Surgery H, Peds Surgery and Vascular Surgery Students
05:00 PM -- M & M Conference – Clinic Auditorium
THURSDAY:
6:30 AM – Rounds – Surgery ICU
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FRIDAY:
6:00 AM – Rounds – Surgery ICU
06:45 AM -- Surgery A Conference – 1155 POB Conf. Rm.
STUDY
Student reading should be directed toward the major surgical problems found in his/her patients. A
standard textbook of surgery is the first priority for this information. Additional reading is encouraged.
CLERKSHIP GRADE
The Final Surgery Clerkship score is determined by the Clinical and the NBME score.

Clinical Score – 50% of Final Score
o 75% service evaluations
o 25% tutorial evaluation

NBME Percentile Score – 50% of Final Score
Surgery Clerkship Grading Scale for Final Grade:
Honors: A Final Score (50% Clinical Score and 50% NBME Percentile Score) in the 75th-100th
percentile
High Pass: A Final Score (50% Clinical Score and 50% NBME Percentile Score) in the 40th –
74th percentile
Pass: A Final Score (50% Clinical Score and 50% NBME Percentile Score) in the 10th – 39th
percentile
Condition: An NBME exam score below the 10th percentile compared with the national sample
is unacceptable and requires that the test be taken again. This will result in a Condition grade.
Once a passing score on the exam has been registered, the surgery clerkship grade will be
converted to a permanent Condition Pass grade.
Fail: A Final Score (50% Clinical Score and 50% NBME Percentile Score) below the 10th
percentile results in a failing grade.
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