STUDENT RESPONSIBILITIES FOR TRANSPLANT SURGERY (SRF)
Learning Objectives
1.
Acquire knowledge in the following surgically-related problems:
Liver Disease; Cirrhosis
End Stage Renal Disease
Immunosuppressed Patient
Liver Transplantation
Renal Transplantation
Liver Tumors
Renal Masses
Nutrition and the Surgical Patient
Dialysis Access
2.
Learn to write structured, focused history and physical examinations and progress notes.
3.
Learn to efficiently evaluate surgical patients and orally present findings, assessment and plan.
4.
Develop Operating Room experience including:
 Proper scrubbing technique
 Participation at the operating table using aseptic technique
 Correlation of pathological findings with signs and symptoms of disease
5.
Acquire patient exposure to refine bedside manner.
6.
Refine technical skills including:



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Venipuncture
Placement and removal of NG tubes and Foley catheters
Dressing wounds and managing drains
Basic suturing
Surgery F Organization
The Division of Abdominal Transplant Surgery is composed of: Drs. Gerber, Kozlowski, Watson and Toledo,
one senior resident PGY3, and one PGY1, as well as a fellow, nurse coordinators and students. The Chief
Residents are responsible for the organization and function of the service. The Chief Residents supervise the
care of all patients on Surgery F. Ultimate responsibility of all patients lies with the Attending Surgeons but the
senior resident is the critical liaison for students. The Administrative Office is located on the 4th Floor, BurnettWomack (966-8008).
Clinics
SRF Clinics meet on Monday and Thursday. New patients, postoperative follow-up evaluations, and
preoperative referrals are seen. Student attendance is required. Most elective cases are admitted through these
clinics.
History and Physical Workups
A major source of learning is obtained from new admission workups. Students are to obtain a complete history
and perform a physical examination on all new admissions or patients seen in consultation who ultimately come
to the surgical service for an operation or management. Occasionally, workups may be done during a clinic visit.
History & Physical workups should adhere to the following format:
Infosource:
Chief complaint: (c.c.)
HPI
PMH (medical, surgical, medications, allergy)
SH (smoking, etc)
FH
ROS (complete, emphasis on pertinent negatives)
PE (complete)
Database
Problem list/Assessment
Plan
Progress Notes
Students are expected to write daily progress notes on the patients they are following. These progress notes do
not replace the housestaff notes. All progress notes should contain the pertinent subjective (S) and objective (O)
findings, as well as a concise assessment (A) and plan (P). The Student Progress Note must be concise and
pertinent. Lab data are recorded. 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 house staff and
Attending physician countersign Student Progress Notes and add comments, corrections, and additions.
Overview for Transplant Surgery F Service:
Welcome to Abdominal Transplant – an interesting mix of general and vascular surgery, as well as critical
care!
1. Please use our detailed “ScutMonkey” that is available on the Abdominal Transplant Surgery
Homepage:
2. http://www.med.unc.edu/transplant/protocols/divispubl
This ScutMonkey is both a brief description of our protocols to help you quickly with direct patient care
to help you learn about transplant in general. When you select “Transplant Protocols”, the pdf will start
to open and will ask you for a password -enter “heels1”. You can download this as a pdf document to
any computer if you wish. Since it is a pdf document, you can use the search function for a word or
phrase. When you open the “ScutMonkey”, you can then open the “bookmarks” on the left to go directly
to your area of interest.
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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. Student operating room assignments will be decided the day before surgery to give each
student ample opportunity to read and prepare for the particular case. It is expected that each student be
familiar with each case on which they scrub. Students should make every effort to see the patients pre-op. At a
minimum their chart should be reviewed. Although the student following an assigned patient is expected to
scrub on that operation, other students are encouraged to view operations whenever possible during the rotation.
All students are expected to be knowledgeable in operating room conduct. 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.
On Call
SRF students are On-Call as directed in the clerkship orientation materials. Please communicate with the senior
resident to identify availability and time off.
Orders
Students are to learn to write postoperative orders. This is done by observing the housestaff during computerized
physician order entry. Proper organization of orders is a high priority. Knowledge of the correct dosage of
medicine, proper laboratory tests, and nursing orders is necessary.
Conferences
There is an abundance of formal teaching sessions that meet on a regularly scheduled basis on Surgery F. The
students should attend as many of these sessions as possible. Priorities include:
1.
2.
3.
4.
7.
Cross Block Lectures - 7:30 am Tuesday/Thursday - OR classroom
Surgery Grand Rounds - 7:15 am Wednesday, Clinic Auditorium
M & M Conference - 5:00 pm Wednesday – Clinic Auditorium
Surgery-F Preop Conference – 8 am Thursday 4052 Burnett-Womack
Tutorials – As scheduled with Attending Physicians
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. Students are responsible for keeping abreast of
the clinical condition of their patients and decisions for management. The Chief Residents supervise 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 should be able to
present a brief, but concise synopsis of the patient's problem and progress on rounds.
Evaluations
Students are encouraged to seek feedback and recognize it in all its forms.
At the completion of each rotation, the attendings and housestaff meet to discuss the performance of the students.
A consensus evaluation form is then submitted to the Surgery Clerkship Office usually within two weeks of the
end of the rotation. Students are encouraged to meet with the Section Chief or other faculty members to review
their evaluations.
Revised 5/30/14
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