MIS objectives for medical students
I.
Operating Room
a. Goal: Be prepared before you arrive to the OR.
i. Objectives
1. Know your patient: Read about patient prior to the case
to understand their medical history and indication for
procedure. Pay particular attention to prior surgeries and
medical conditions that may be important
postoperatively.
2. Know the proposed operation: Review relevant anatomy
and the basics steps of the operation.
b. Goal: Understand how to prepare a patient prior to the operation.
i. Objectives
1. Meet patient in the pre-op area, assist CRNA/Resident/PA
in bringing them to room
2. Help to properly position patient
3. Understand how to properly prep the patient
4. Become proficient at Foley placement
5. Understand the principles of sterile technique
c. Goal: Understand basic surgical technique.
i. Objectives
1. Be able to properly drive the laparoscopic camera
2. Be familiar with basic surgical instruments and their
proper use
a. Laparoscopic graspers (Alligator, duckbill)
b. Staplers
c. Energy Devices (Harmonic, Ligasure)
d. Endo Catch Bag
e. Scalpels (#10, #11, #15)
f. Scissors
g. Forceps (Adsen/”Bunnies”, DeBakey)
h. Needle Driver
3. Become proficient in basic suturing (running and
interrupted subcuticular stitch)
d. Goal: Understand proper perioperative care.
i. Objectives
1. Accompany patient to PACU
2. Understand basic post-operative orders
3. Understand common postoperative problems, their
evaluation and proper management
a. Hypotension
b. Tachycardia
c. Postoperative nausea
d. Low urine output
II.
Floor
a. Goal: Be an active member of the care team.
i. Objectives
1. Contact resident regarding time/location to meet for
rounds.
2. Arrive prior to resident and evaluate patients on whom
you have operated
3. Formulate plan for patients
a. Orders
b. Tests
c. Medications
d. Diet
e. Activity
f. Consults
4. Present patient on morning rounds to resident and review
plan
5. Write a note for those patients (forwarded to both
resident and Dr. Hamad) but DO NOT SIGN it until you
have discussed the plan with a resident/fellow.
6. Present patients to attending during afternoon rounds
7. Follow-up on any labs/tests that were ordered for that
day
8. Understand how to prepare a patient for discharge
b. Goal: Learn how to evaluate an inpatient/ED consult
i. Objectives
1. Learn how to take a surgery-focused H&P
a. Prior surgeries (including where and by whom they
were performed)
b. Scars, drains, tubes
2. Understand the workup for common surgical chief
complaints
a. Abdominal pain
b. Nausea/Vomiting
c. Abscess/wound infection
3. Know how to write basic admission orders
c. Goal: Become comfortable interpreting radiographic images.
i. Objectives
1. Be able to identify common pathologies seen on an acute
abdominal series
III.
a. SBO
b. “Free Air” (pneumoperitoneum)
2. Be able to identify common pathologies seen on a CT
scan of the abdomen/pelvis
a. “Free Air” (pneumoperitoneum)
b. SBO
c. Hernia
d. Abscess
3. Be able to identify common pathologies seen on right
upper quadrant ultrasound
a. Gallstones
b. Signs of cholecystitis (gallbladder wall thickening,
pericholecystic fluid)
4. Be familiar with HIDA scans and their utility.
a. Acute cholecystitis
b. Biliary dyskinesia
d. Goal: Understand the importance of multidisciplinary care.
i. Objectives
1. Understand the principles of systems-based practice
2. Understand how to call a consult and communicate with
consultants
3. Understand the importance of the care manager/social
workers
Clinic
a. Goal: Learn how to evaluate a surgery clinic patient.
i. Objectives
1. Interview/examine new patients and present to
resident/PA, then attending
2. Complete the Chief Complaint, Medications and History
sections of patient encounter in EPIC
3. Be familiar with the diagnostic and preoperative workup
for the following procedures:
a. Roux-en-Y Gastric Bypass
b. Laparoscopic gastric banding
c. Cholecystectomy
d. Ventral hernia repair
e. Inguinal hernia repair
4. Understand the risks and benefits of the same procedures
Patrick Varley, MD
Rounds Presentation Format for Medical Students
- Describe patient: age, gender, procedure or chief complaint, length of hospital
stay/days post-op
- Overnight events- e.g. ICU transfer, CT scan to rule out PE, room light falling
on patient’s head (this actually happened)
- Subjective:
- Pain
- Nausea, vomiting
- Flatus, bowel movement
- Chest pain, SOB
- Tolerance of diet & what kind of diet (e.g. clear liquids)
- Objective:
- T max over last 24 hrs, T current if T max was >101.5
- HR range
- BP range
- I & O (include urine output, drain and NG outputs)
- Physical exam: heart, lungs, abdomen, wounds, drain fluid
- Pertinent labs
- Antibiotics and # of days on them
- Radiologic studies done in past 24 hrs
- Assessment: diagnosis- whether pt is stable or not
- Plan (may do by systems if it helps to organize, or if pt is in ICU)
- Neuro (including pain management)
- Cardio
- Pulm
- Fluids/electrolytes/nutrition
- GI
- Renal and GU
- Hematology
- ID
- Prophylaxis
- Medication changes
Disposition
Janie Yue Zhang, MS-3