Student Responsibilities for Trauma/Critical Care (SRH)
Learning Objectives
1.
Acquire knowledge related to:
a) Trauma – resuscitation, evaluation and diagnosis, care of specific
conditions, North Carolina trauma system
b) Surgical critical care including use of invasive lines, ventilator
management, nutrition, sedation
c) Preoperative risk assessment and post operative complications
d) Acute abdomen including presentations related to peptic ulcer disease,
biliary disease, large and small bowel obstruction, diverticular disease,
appendicitis
e) Hernia
f) Miscellaneous other general surgical problems
2.
Learn to efficiently evaluate surgical patients
3.
Learn to write focused history and physical examinations and progress notes.
4.
Learn effective oral patient presentation skills
5.
Develop Operating Room experience including:
a)
b)
c)
d)
Proper scrub technique
Participation at the OR table
Correlation of pathological findings with signs and symptoms of disease
Understanding of operative decision-making
6.
Understand the importance of multidisciplinary care and participate with
RN’s, physical therapy, speech therapy, social work and members of the
trauma program
7.
Develop technical skills including:
a)
b)
c)
d)
Venipuncture
Placement and removal of NG tubes, foley catheters
Dressing wounds and managing drains
Basic suturing
SRH organization
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Division of Trauma and Critical Care is responsible for all trauma evaluations and
admissions. We are also one of three services performing adult general surgical
procedures. We have 5 attendings including Drs. Charles, Dreesen, Marshall, Rich,
Stafford. Our team also includes one chief resident, two PGY2s, two-three PGY1s, as
well as rotating residents from Emergency Medicine and Physical Medicine. We also
work with the Trauma Program which includes a Director, an Outreach coordinator,
trauma registrars, an alcohol and other disease counselor. The Chief Residents are
responsible for the organization and function of the service and they will orient incoming
students.
Student Responsibilities on SRH
Students play an important role on the service. They have responsibilities, first and
foremost, to the patients they care for. They are also part of a team, with attendant
responsibilities to their team members including fellow students, residents and attendings.
Students learn about surgery through a combination of patient care, didactic teaching,
reading, OR exposure, the composition of written and oral patient presentations.
Students are expected to know thoroughly, pre-round on, assemble data on, and present
all patients that they admitted and all patients in whose operations they participated (up to
a total of five patients at a time).
Students are also expected to play a lead role in maintaining the list of service patients.
The interns on the service will show the students how to accomplish this task.
Operating Room
Students should decide the night before in conjunction with the chief resident which
cases they will scrub on. They should read and prepare for their cases. Due to the
nature of trauma and general surgery, the OR schedule changes frequently. This requires
everyone, including the students to be flexible. Students should check the schedule at the
OR front desk frequently and should work together to cover all the SRH service cases,
unless they conflict with a mandatory meeting or conference. When students do have
conferences, they are expected to be in OR up until & immediately after these
conferences.
On Call
SRH students are on call as directed in the clerkship orientation materials. Each on-call
student should notify the Resident On-Call where s/he can be reached.
Clinic
Students are expected to be in clinic on clinic days which are Tuesday mornings on the
2nd and 4th Tuesday of the month (trauma f/u clinic) and all day Thursday (general
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surgery clinic). Students are expected to evaluate patients in clinic and then present these
patients to either an attending or the chief resident. Presentations should include a basic
history, physical, assessment and plan. Students are expected to be in appropriate attire
for clinic & rounds daily.
History and Physical Workups
Each student is expected to write up three history and physical workups and turn them in
to Dr. Dreesen in printed form. Patients may be written up when they present as red or
yellow trauma admissions during the day or when the student is on call with either the
trauma intern or the senior-in-house. You may also write up patients who are worked up
in clinic and scheduled for surgery. You may also write up any general surgical
admissions or consults that the service evaluates.
History and Physical workups should adhere to the following format:
Info source
Chief Complaint
HPI
PMH (med, surg, meds, allergies)
SH
FH
ROS (focus on pertinent positives and negatives)
PE
Data
Problem List/Assessment
Plan
A critical task of the surgical student is to learn to formulate a surgical differential
diagnosis and to choose tests and plans that allow one to sort out the differential. Your H
and P should have a well thought out differential and plan.
Please handwrite or type this and turn it on electronically or on paper to Dr. Dreesen
within 24 hours of seeing the patient.
Progress Notes
Students are expected to enter one progress note daily into WEBCIS Med student notes
(please do this in the generic field) and forward the note to Dr. Dreesen.
Conferences
1.
The department as a whole has a variety of lectures that are mandatory for
students.
3
a.
b.
c.
d.
e.
2.
AM lecture series
Tutorials
Dr. Sheldon rounds
Dr. Meyer rounds
Departmental M and M at 500 Wed in OR classroom
The Division of Trauma and Critical Care also has conferences which you are
expected to attend
a. Critical Care Conference – Monday Noon in BW 4050
b. Second and fourth Tuesdays 2-4 Trauma M and M BW 4050
c. First, third and fifth Wednesday 9-11 Trauma Teaching Conference BW
4050
d. Surgery pre-op conference 8:00 Thursday BW 4050
Oral Presentations
Each student should choose a topic related to a patient that they saw and prepare a ten
minute presentation on it including some literature review for presentation to Dr. Dreesen
and their fellow students.
Evaluations
Mid-rotation feedback will be provided by faculty members at the two week point.
At the completion of each rotation, the attendings and housestaff discuss the performance
of the students. A consensus evaluation form is submitted to the clerkship office.
We strongly seek feedback on this rotation and encourage students to thoughtfully fill out
evaluation forms.
IF YOU ARE LOST
If you find that you do not know what you should be doing, ask your chief resident.
While there are down times on this service, there is almost always something you could
be / should be doing. Places you ought to be include:
1.
2.
3.
4.
The OR
Clinic
Seeing consults with the PGY2 resident
Assisting PGY1s with floor work, learning about the roles of the many allied
health providers involved in care of the trauma pt
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5. Working on procedures – ICU & OR provide frequent opportunities for drawing
ABGs or placing PIVs or placing NGTs, etc.
6. Reading to prepare for your cases or reading about things you have seen on-call.
This means reading STANDARD surgical texts, not simply test prep books.
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