SURGERY CORE CLERKSHIP (SU019)
2013-14
Course Description: This course is designed to provide the student with a balanced, multidisciplinary
perspective of the surgical sciences. The objectives are to provide an understanding of the surgical management
of disease, to illustrate special problems encountered with surgical patients, to fix clearly in the student’s mind
the means available for establishing diagnoses of surgical problems, to expose the student to the expectations
and limitations of appropriate surgical therapy, and to give students familiarity in the pre- and post-operative
care of patients. Major surgical problems are presented such that a correlation between clinical observations,
surgical (operative) pathology, and the physiological alterations brought about by operation can be made. This
background is intended to lead the student to appreciate both the philosophy and practice of surgery and their
relationships to the medical practice in general.
Students are required to complete the 12 week surgery course which consists of exposure to both inpatient and
specialty surgery. This will be organized into two principal rotations, each of six weeks duration: the inpatient
rotation encompassing General Surgery, Vascular, Trauma, Oncology and Pediatric Surgery; and three 2 week
rotations from these specialties: Orthopaedic Surgery, Otolaryngology, Urology, Ophthalmology,
Anesthesiology, Plastic Surgery, Neurosurgery, Transplant Surgery, Cardiac and Thoracic Surgery, and
Emergency Medicine. Each student will be assigned to rotations at some or all of the following locations:
UCLA, Ronald Reagan UCLA Medical Center, West Los Angeles VA Medical Center, Santa Monica-UCLA
Medical Center and Orthopaedic Hospital, Kaiser Permanente LAMC, Cedars-Sinai Medical Center, Olive
View-UCLA Medical Center, and Harbor-UCLA Medical Center. Objectives of the course in Surgery are the
same at all locations, but administrative details and the flavor of the course will differ somewhat in each
hospital.
Co-Course Chairs:
David C. Chen, M.D.
Santa Monica-UCLA Medical Center
1304 15th Street, Suite 213
Santa Monica, CA
Tel: 310-319-4080
dcchen@mednet.ucla.edu
Christian de Virgilio, M.D.
Harbor-UCLA Medical Center
Division of Vascular Surgery
1000 West Carson Street, Box 25
Torrance, CA 90509
Tel: 310-222-2531
cdevirgilio@labiomed.org
Course Coordinator:
Iris Mau
Surgery Education Office
10833 Le Conte Avenue, 72-215 CHS
Los Angeles, CA 90095
Tel: 310-206-2567
imau@mednet.ucla.edu
In addition to the Course Chairs, there are Site Directors that will oversee your educational experience during
the 12-week clerkship, as well as Coordinators at each site.
Cedars-Sinai Medical Center Site Director and Coordinator:
Nicolas Melo, M.D.
Tel: 310-423-8354
nicolas.melo@cshs.org
Donald Dafoe, M.D.
Tel: 310-423-7899
donald.dafoe@cshs.org
Alan Pierce
Tel: 310-423-3277
alan.pierce@cshs.org
Harbor-UCLA Medical Center Site Director and Coordinator:
Christian de Virgilio, M.D.
Tel: 310-222-2531
cdevirgilio@labiomed.org
Ravin Kumar, M.D.
Tel: 310-222-2706
rkumar@ucla.edu
Kristan Holstrom
1000 West Carson Street, Box 42
Bldg. F-7
Torrance, CA 90509
Tel: 310-222-5251
kholstrom@labiomed.org
Olive View-UCLA Medical Center Site Director and Coordinator:
Darin Saltzman, M.D.
dsaltzman@mednet.ucla.edu
Melinda Maggard Gibbons, M.D.
mmaggard@mednet.ucla.edu
Lorena Ponce
14445 Olive View Drive, Room 2B156
Sylmar, CA 91342
Tel: 818-364-3198
loponce@dhs.lacounty.gov
Santa Monica-UCLA Medical Center Site Director:
David C. Chen, M.D.
Santa Monica-UCLA Medical Center
1304 15th Street, Suite 213
Santa Monica, CA
Tel: 310-319-4080
dcchen@mednet.ucla.edu
Cary Hsu, M.D.
caryhsu@mednet.ucla.edu
West LA VA Medical Center Site Directors:
Jessica O’Connell, M.D.
joconnell@mednet.ucla.edu
Mark Sawicki, M.D.
mark.sawicki@va.gov
Kaiser Permanente LAMC Site Director:
J. Craig Collins, M.D.
Tel: 323-783-0256
j.craig.collins@kp.org
UCLA Site Directors and Coordinator:
Jonathan R. Hiatt, M.D.
Tel: 310-825-8340
jhiatt@mednet.ucla.edu
Iris Mau
Tel: 310-206-2567
imau@mednet.ucla.edu
Clerkship Objectives: The surgery clerkship is designed to provide the student with a balanced,
multidisciplinary perspective of the surgical sciences. The objectives are:
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To understand the surgical management of disease.
To understand the clinical and technical resources available for diagnosing surgical problems.
To appreciate expectations and limitations of appropriate surgical theory.
To gain familiarity with the pre- and post-operative care of patients.
To learn, through the presentations of major surgical problems, to establish correlations among clinical
observation, surgical (operative) pathology, and the physiological alterations achieved through surgery.
To appreciate the philosophy and practice of surgery and their relationships to general medical practice.
To appreciate strengths of a sampling of surgical subspecialties.
To appreciate the nature of surgical health care delivery at a variety of institutions - e.g., private, county,
academic medical center, V.A. Administration, etc.
To understand the system of surgical health care delivery to both inpatients and outpatients in a variety
of settings, such as private, county, academic medical center, VA Administration, etc.
To become familiar with ward procedures.
To participate in patient care activities
To function as a member of the surgical team.
To appreciate the entire treatment cycle of the surgical patient from diagnosis to operative management
and through recovery.
Clinical Responsibilities: Students will be assigned to evaluate and follow both inpatients and specialty
patients and are considered part of the treatment team of each service. Although they will not have primary
responsibility for ward duties, they will be expected to become familiar with ward procedures and to participate
in patient care activities. The association of students provides teaching on the wards with all levels of the staff;
including junior and senior housestaff and faculty. Students are expected to follow their patients to the
Operating Room where they may be asked to "scrub", such that the entire treatment cycle of the surgical patient
from diagnosis to operative management and through recovery can be observed. Attendance at the student
lecture series and certain departmental conferences are required of all students on all rotations.
You will be expected to attend and participate in the clinics on the services you rotate through. You will be
scheduled to be on-call by the Attending/Chief Resident on the service. The on-call schedule varies with the
service to which the student is assigned. There is up to a 28 hr. max in-house call. If you come in at 6am you
are to go home no later than 12pm the next day. There should be a minimum of 6 hours off between shifts.
Duty Hour Policy: 6 hours of rest required between shifts.
Clerkship Requirements: In addition to passing the clerkship final examinations and fulfilling all of your
clinical responsibilities with satisfactory evaluations the following are additional course requirements for the
core clerkship in Surgery.
Conference Attendance: The department has established protected educational conferences for all surgical
residents and students on Wednesday mornings held in room 73-105 CHS. All students rotating through
surgery and specialty services except for students at Harbor and Cedars are required to attend. Students are
expected to be prompt and dressed professionally for these conferences. No scrubs.
During the three-hour consecutive block students will be unavailable for clinical duties. The three one –hour
sessions are as follows:
7:00 am - Surgical Morbidity & Mortality (M&M)
8:00 am - Grand Rounds or Surgical Core Curriculum
9:00 am - Core Lecture Series for medical students
For the Core lecture Series a schedule of lecture topics is located on ANGEL. In addition, you can find
PowerPoint presentations on most topics for your review.
Patient Case Log Requirements: Students are required to enter 5 core problems a week using the Patient Case
Log Portal System in ANGEL. The core problems seen may be via real patient encounters or via didactics (case
discussion, video case, simulation, paper case, etc.).
Core list of complaints, diagnoses, and procedures that you are required to track on this rotation:
COMPLAINTS:
Abdominal pain
Acid-base disturbance
Breast lump
Fluid and electrolyte disturbance
Multisystem trauma
Rectal bleeding
Rectal pain/discomfort
Varicose veins
DIAGNOSES:
ANESTHESIOLOGY
Approach to failed intubation
Code Basics
Local anesthetic toxicity/doses
Opioids/pain management
Pre-Oxygenation (maintain sat. during airway mgmt)
GENERAL SURGERY - Clinical problems
Appendicitis
Biliary/Pancreatic disease
Bowel obstruction
Colorectal/Anorectal Disease
Esophageal/Gastric Disease
Hernias
Surgical infections
Thyroid and parathyroid disease
Trauma (Blunt/Penetrating)
GENERAL SURGERY - Perioperative care
Fluid and electrolytes
Informed consent
Postoperative care
Preoperative evaluations
Wound/Intestinal stoma management
HEAD AND NECK
Neck mass
Otitis
Thyroid and parathyroid disease
NEUROSURGERY
Brain tumor
C-spine trauma
Head trauma
Intracranial hemorrhage
ONCOLOGY
Breast disease
Colon cancer
Melanoma
OPHTHALMOLOGY
Cataract
Conjunctivitis
Corneal abrasion
Diabetic retinopathy - proliferative
Papilledema
ORTHOPAEDICS
Arthritis
Fractures
PEDIATRICS
Abdominal wall defects
Intussusception
Pediatric intestinal obstruction
PLASTIC SURGERY
Postmastectomy reconstruction
Skin grafts
UROLOGY
Benign prostatic hypertrophy
Kidney stones
Prostate disease
Varicocele
VASCULAR
Aneurysmal disease
Carotid artery disease
Venous disease
Resources for Learning: Students are encouraged to read the 4th edition of "Essentials of General Surgery" by
Peter Lawrence, as well as the "Essentials of Surgical Subspecialties".
Additional Texts (recommended but not required):
Title – General Surgery
Author
Surgery, A Clinical Approach
Bongard/Stamos/Passaro
Textbook of Surgery
Textbook of Surgery
Schwartz
Sabiston
Mount Sinai Handbook of Surgery
Joel Bauer
Current Surgical Diagnosis and Treatment
Current Surgical Diagnosis And Treatment
Cameron
Lawrence Way
Rowe O'Neill, Grosfeld,
Fonkalsrud, Coram
Author
Grabb & Smith
Essentials of Pediatric Surgery
Title – Surgical Specialty
Plastic Surgery
Textbook of Disorders of the Musculoskeletal System Salter
Essentials of Neurosurgery
Surgery of the Chest
Glenn's Thoracic & Cardiovascular Surgery
One Hundred Orthopaedic Conditions Every Doctor
Should Understand
Essentials of Musculoskeletal Care
Urology for the House Officer
Primary Care/Otolaryngology
Smith
Sabiston & Spencer
Bave
St. Louise
Snider
Michael Macfarlane
Provided by Diacchi
Pharmaceuticals
Publisher
Churchill
Livingston
McGraw-Hill
Saunders
Williams &
Wilkins
Year Book
Lange
Publisher
Little/Brown
Williams &
Wilkins
Lippincott
Quality Medical
Pub.
AAOS
Absences: It is the student’s responsibility to notify his/her team in advance of any absence. For each day that
a student misses from the rotation, the course chair or site director may require the student to make up the time.
If you are unable to show up for work due to illness please notify Iris Mau at 310-206-2567 or email
imau@mednet.ucla.edu. For this 12-week rotation, a student may miss up to 3 days due to illness before risk of
repeating the entire rotation.
Grading Policy: All students will take a written and practical final examination. Students are reminded that
although they may not be assigned rotations on every surgical specialty service they are expected to have a
working knowledge of the major principles of each and may be examined on these. The student grade for the
Surgery Clerkship is composed of several elements: the clinical performance (50%), the practical examination
(25%), and the final written exam (25%).
In order to pass the clerkship students must attain passing grades in all elements of the course. Failing any
element of the course will result in a “Fail” grade for the course.
Failures of any of the various course elements may be remediated with either re-examination, repeat clinical
rotation, and or both. Any failures will be referred to the Dean for review.
Criteria for Letters of Distinction in Surgery
 Criteria: Excellence in Clinical, Practical, and Shelf Examination
 Clinical: Uniformly Performance Exceeds Expectations to Outstanding Performance MyCourses Evaluations
from Residents and Faculty in all blocks (General and Specialty). Must receive a score of 4.5 in every category
To understand what demonstrates an outstanding clinical performance, please see the descriptors listed
below:
 History taking: Precise, logical, thorough, reliable, purposeful, and focused. Includes all pertinent positives
and negatives.
 Physical examinations: Very complete, accurately done, directed toward patient's problem(s), and elicits
subtle findings.
 Case Presentations: Extremely clear, organized, complete, accurate, and polished presentation appropriate in
length to the situation. Uses precise, accurate terminology.
 Write ups: Outstanding, conscientious and accurate in recording patients' histories and physical exams.
Differential diagnoses are extensive. Outstanding analysis of patient's problems. Therapeutic plans are
thorough.
 Medical Knowledge: Extensive, well-applied knowledge of disease, pathophysiology, diagnosis, and therapy.
Consistently up to date. Familiar with relevant current journal articles.
 Clinical Judgment: Regularly integrates medical facts and clinical data, weighs alternatives, costs, risks and
benefits. Understands limitations of knowledge. Wise use of diagnostic and therapeutic procedures. Regularly
applies evidence-based medicine.
 Physician Patient Interactions: Does not use jargon. Communication with patients and families reflects clarity
and empathy. Effective communicator with teams, staff et al.
 Professional Attitude and Behavior: Enthusiastic, responsive, reliable. Committed, cooperative and
respectful. Establishes trust. Displays initiative.
 Practical: Excellent Performance. Must receive a score of 90 percent or above.
 Shelf Exam: Consider those that score 85 or above (standardized score, not percentile) on the Surgery Subject
Exam.