Department of Physician Assistant Studies
Learning. Caring. Serving. Leading.
PAS 638: Surgery
3 Semester Hours
Course Director:
Diane Duffy, MD
Tracey Tonsor, PA-C
Office
FC 205
FC 207
Phone
336-278-6848
336-278-6852
E-mail
dduffy2@elon.edu
ttonsor@elon.edu
Course Description: The Surgery clinical rotation is designed to give students experience in the care of
patients undergoing elective or acute surgical procedures. The student will perform the pre-operative
history and physical; assist, when able, in the operating room; be involved in immediate post-operative
care and stabilization; and assist with post-operative follow up.
Course Goals: The educational goals of the Surgery rotation include:
1. To apply the medical content and principles that define the care of surgical patients.
2. To provide opportunities for each student to develop the core PA competencies in a supervised
surgical setting.
3. To expose each student to an experienced and competent medical provider role model for the
care of surgical patients.
Learning Outcomes:
Upon completion of this course the clinical phase PA students will:
1. Obtain and document an appropriate surgical history and physical examination.
2. Demonstrate the ability to apply knowledge of surgical principles to develop a working diagnosis
and treatment plan for common surgical problems, taking into account clinical epidemiology
and probabilistic reasoning.
3. Demonstrate an understanding of the appropriate diagnostic tests used in the evaluation of the
surgical patient and an ability to correctly interpret results from these studies.
4. Determine the appropriate use of medications, fluids, and anesthetics in the surgical patient.
5. Properly perform/assist and document surgical procedures under the supervision of the
preceptor including wound closure.
6. Be able to communicate in a medically professional manner, both orally and in writing, with the
patient, the family and health care professionals.
7. Demonstrate proficiency in creating and maintaining the medical record of the surgical patient.
8. Be able to recognize and jointly manage life-threatening emergencies.
Revised 10/23/13
9. Participate in and complete discharge planning with the healthcare team and patient to include
writing prescriptions, arranging for outpatient or home therapies, and setting up follow-up
visits.
10. Assure smooth and thorough transfer of care back to referring or primary care health care
provider.
Teaching Methodologies: The content of this module will be presented through a variety of methods
that include observation and participation at the clinical site, independent reading and participation in
online activities developed to guide experiential learning.
Accommodations: Students requiring academic accommodations must follow the “Academic Support”
policy in the Elon University DPAS Student Handbook.
Academic Honesty: All Elon PA students acknowledged their commitment to abide by the Elon Honor
Code by signing the Honor Pledge during orientation. Students will sign an Honor Pledge (electronically
or manually) each time an assignment is turned in or an examination is started to reaffirm their
complete understanding of the Honor Code of Elon University and their affirmation that their work
abides by that Code.
Required Textbooks:



All first-year required textbooks.
Essential of General Surgery by Lawrence, 3rd Ed.
Surgical Recall by Blackbourne, 2nd Ed. ISBN: 0-683-30102-0 (Optional)
Other Resources:
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*Moodle: Please check the course site frequently for new announcements, updated schedules,
assignments and other course communication.
Practicing physician assistants, physicians, allied health care providers and laboratory teaching
aids.
Revised 10/23/13
Assessment Activities:
Exams/quizzes (25%), Preceptor Evaluation (65%), Professionalism (10%).
Grade Scale and Grade Points
Percentage
89.50-100
85.50-89.49
79.50-85.49
75.50-79.49
69.50-75.49
Below 69.50
There is no rounding of grades.
Letter Grade
A
B+
B
C+
C
U
Grade points
4.0
3.3
3.0
2.3
2.0
0
Note: For further information regarding academic standing in the Department of Physician
Assistant Studies, please see the Student Handbook.
Grading Criteria:
1. Demonstrate acquisition of a strong basic science and medical science knowledge base as
demonstrated on the written examination/quizzes.
2. Demonstrate satisfactory self-directed learning skills, clinical reasoning skills, commitment to
patient-centered care and professionalism as evidenced by satisfactory performance on the
preceptor evaluation.
3. Demonstrate a commitment to learning and professionalism by actively participating in all clinical
activities and exceeding the professional behavior standards and minimum requirements for clinical
rotations available in the Elon PA Student Handbook.
Instructional Objectives:
Upon completion of the clinical rotation clinical phase physician assistant students will be able to:
1. Clinical Skills
a. Demonstrate the ability to obtain an accurate and appropriate surgical history
documenting all information from available sources such as patient and family;
recognizing and accounting for comorbid disease states; and taking into account any
medications the patient is using.
b. Perform and document appropriate physical examination for pre-operative screening
and post-operative follow-up.
c. Ensure proper pre-operative preparation of the patient.
2. Identify, perform, order and/or interpret appropriate, cost-effective, routine, diagnostic
procedures, based on history and physical examination findings, and be able to assist the
physician with other diagnostic procedures as directed.
Revised 10/23/13
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
a. Identify the appropriate and available diagnostic tests for a particular problem based on
the history and physical examination findings.
b. Identify and discuss indications and contraindications of diagnostic tests
c. Identify and describe the risks, costs, and patient inconvenience of diagnostic tests.
d. Demonstrate the skills required to collect routine specimens including bacteriologic
samples, venous and arterial blood, sputum, and urine.
Discuss the appropriate use of medications in the surgical patient related to such issues as
dosage, indications, contraindications, interactions, complications, metabolism and excretion in
the following settings:
a. Pain management
b. Perioperative antibiotic usage
c. Chemotherapy
d. Inpatient considerations (e.g. sleep medications, anti-emetics, laxatives)
Discuss anesthetics, their indications, modes of action, contraindications, complications and
combinations in:
a. General anesthesia
b. Spinal and regional anesthesia
c. Regional anesthesia/field blocks
Know the composition of fluids that are frequently lost from the body, including urine, gastric
secretions, diarrhea, third spaced fluids, and hemorrhage and be able to compensate for the
loss of these fluids through the proper utilization of IV fluid, blood or blood product therapy.
Understand the role interpreting serum electrolytes plays in determining the replacement fluid.
Recognize the signs and clinical manifestations of hypovolemia and hypervolemia and institute
corrective measures.
Practice proper technique in the following settings
a. Demonstrate knowledge of and ability to scrub and gown for surgery, position patient,
maintain sterile technique, tie knots, suture/staple, apply dressings, transfer patient to
and from O.R. table, hold retractors.
b. Demonstrate ability to set up a sterile field outside the O.R. (for office procedures)
Be competent in wound closure techniques
a. Know the various techniques for dermal closure
b. Discuss the different types of suture materials and their uses including silk, gut, chromic,
nylon, Dacron and vicryl.
Demonstrate I & D of an abscess.
Identify and manage problems common to peri-operative management of the surgical patient
such as DVT/PE prophylaxis, infection, mobility and ambulation, blood conservation and
management.
Present to the physician a brief synopsis of the patient’s illness, pertinent positive and negative
findings and the diagnostic and therapeutic regimen instituted.
Communicate effectively with the patient and family regarding the disease process, risks,
expected outcome, possible side effects, and post-operative care.
Document the care of the surgical patient
Revised 10/23/13
14.
15.
16.
17.
18.
a. Write clear, concise and relevant progress notes delineating diagnostic, therapeutic and
patient education plans
b. Dictate or otherwise document the discharge summary
c. Maintain a complete up-to-date problem list
Recognize signs and symptoms of common emergencies and take appropriate action to sustain
life
a. Apply basic techniques of CPR
b. Assist with or perform other techniques frequently indicated in life-threatening
situations (e.g. endotracheal/nasogastric intubation; defibrillation/cardioversion; central
line insertion, central venous pressure monitoring)
c. Initiate hemostasis in a patient with hemorrhage
d. Assess and treat hemorrhagic shock
e. Be familiar with triage procedures in mass casualty situations.
f. Assess patients with multiple trauma, skull and/or spinal injuries.
Work with medical team and patient to formulate a complete discharge plan anticipating and
arranging for discharge medication prescriptions, outpatient or home therapy services,
home/self care instructions and scheduling follow-up.
Anticipate specific needs of the patient being sensitive to the patient’s home environment,
change in level of care needed based on post-surgical condition and ability to perform activities
of daily living.
Coordinate communication with the patient’s primary care and/or referring physician to allow
for smooth transition of care.
Describe the following common surgical problems, including risk assessment, pathophysiology,
diagnosis, treatment, indications and contraindication for surgery and follow-up:
Topics
Pre-operative/Postoperative
Cardiovascular
Gastrointestinal (cont’d)
Revised 10/23/13
Care
Risk assessment:
Cardiac disease: history of ,
MI, unstable angina, valvular
disease, hypertension
arrhythmias, heart failure
Pulmonary disease: history
of diabetes, adrenal
insufficiency
Hematologic disease: history
clotting disorders,
anticoagulant use
Tobacco use/dependence
Substance abuse
Post-operative fever
Wound infections
Deep venous thrombosis
Fluid/volume disorders
Electrolyte disorders
Acid/base disorders
Hematologic System
Easy bruising/bleeding
Anemia
Fatigue
Chest pain; history of angina
Syncope
Dyspnea on exertion
Claudication
Aortic Aneurysm/dissection
Arterial embolism/thrombosis
Peripheral arterial disease
Arterial/venous ulcer disease
Varicose veins
Gastrointestinal
Abdominal pain
Anorexia
Heartburn/dyspepsia
Nausea/vomiting
Jaundice
Hematemesis
Diarrhea/constipation/
obstipation/change in bowel
habits
Melena/hematochezia
Esophageal cancer
Hiatal hernia
Peptic ulcer disease
Gastric cancer
Pancreatic pseudocyst
Pyloric stenosis
Acute/chronic cholecystitis
Pancreatic carcinoma
Appendicitis
Inflammatory bowel disease
Small bowel carcinoma
Toxic megacolon
Colorectal carcinoma
Diverticular disease
Bowel obstruction (small,
large, volvulus)
Anal disease (fissures,
abscess, fistula)
Hemorrhoids
Hernias (inguinal, femoral,
incisional)
Bariatric surgery
Pulmonary
Shortness of breath
Hemoptysis
Weight loss, fatigue
Lung carcinoma
Pleural effusion
Pneumothorax
Pneumonia (post-operative)
Topics (cont’d)
Genitourinary
Edema
Endocrinology
Tremors
Dermatology
Rash
Revised 10/23/13
Orthostatic hypotension
Urinary retention
Dysuria
Fluid and electrolyte
disorders
Testicular carcinoma
Wilm’s Tumor
Bladder carcinoma
Renal cell carcinoma
Chronic renal failure
(shunts/access)
Renal vascular disease
Nephrolithiasis
Fatigue
Palpitations
Heat/cold intolerance
Hyperparathyroidism
Hyperthyroidism
Thyroid nodules
Adrenal carcinoma
Pheochromocytoma
Women’s Health
Pain
Skin Changes
Nipple discharge
Adenopathy
Benign breast disease
(fibroadenomas, fibrocystic
breast disease)
Breast carcinoma
Redness/erythema
Discharge
Drug eruptions (postoperative)
Urticaria (post-operative)
Cellulitis
Burns
Pressure ulcers
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Neurology (Neurosurgery)
Change in vision
Change in speech
Motor and/or sensory loss
Vascular disorders (carotid
disease)
Subarachnoid hemorrhage
Subdural hematoma
Epidural hematoma
Revised 10/23/13