GENERAL SURGERY ELECTIVE SUR 801 Course Title, Department, & Number: SUR 801, General Surgery Course credit or length: 2-4 Weeks Course director and contact information: David Denning, MD, 304.691.1280 Course Coordinator and contact information: Lisa Clagg-Blizzard, 304.691.1281; Clagg@marshall.edu Course location: Cabell Huntington Hospital Description and Goals of Course: The surgical sub-internship in surgery is meant to give the student who is interested in surgery a more in depth experience in surgery. The student will take on the responsibilities of an intern. In this capacity, he or she will see consults in the emergency room and on the floor, manage patients that have been admitted to the service, and assist in the operating room. Objectives of the Elective: This rotation introduces the student to general surgical principles including pre-op evaluation, intra-op decision making and post-op care. Students will deal with surgical illness, surgical critical care and nonoperative care of the critically ill. Students should become “experts on the abdomen.” This elective is a chance for the soon-to-be resident to gain and/or polish the clinical skills critical for entering residency. The student should actively participate in procedures, clinical decision-making, and patient interaction. Call responsibility will be addressed by the attending surgeon and Chief Resident. This month is a chance to establish a preliminary comfort level in taking care of patients and is designed to simulate what it may be like as a PGY-1, with appropriate supervision. INSTITUTIONAL GOALS AND OBJECTIVES MET OR ADDRESSED Patient Care: During this rotation, students will: 1. Develop skills to complete an initial assessment of the patient and his/her problems (e.g., to distinguish the patient who needs intervention now from the "sick" patient with less acute needs). 2. Manage the short-term needs of the acutely sick patient. 3. Formulate a diagnosis and a plan of treatment 4. Directly participate in the care of surgical patients; that is, initial evaluation, formulation of differential diagnoses, the establishment of treatment plans and eventual daily care of the patient. 5. Demonstrate basic knowledge of and initial management of patients with clinical presentation of surgical diseases of the GI tract, breast, abdominal wall, vascular system, endocrine systems, 1 trauma/critical care etc., their evaluation and management. Medical Knowledge: The student will: 1. Understand the approach to the preoperative and postoperative management of the surgical patient. 2. Have an increased understanding of the pathophysiology of surgical disease. 3. Have an increased understanding of ambulatory surgical care. 4. Have a basic knowledge of various drug overdose syndromes and associated anecdotal treatments. 5. Have a basic knowledge of the pathophysiology, assessment and management of respiratory failure (including interpretation of EKG’s and the use of mechanical ventilation). 6. Have a basic knowledge of the pathophysiology and management of shock and multiple organ failure syndrome (including the use and interpretation of invasive hemodynamic monitoring). 7. Be familiar with the nutritional support. 8. Be familiar with the common general surgical procedures such as a. b. c. d. e. f. g. h. i. j. k. Acute care of surgery Appendectomy Gall bladder Hemorrhoidectomy Hernia repair Peptic ulcers Skin liaisons Soft tissue tumors Small bowel resection Trauma/Critical Care Vascular surgery 9. Have a basic knowledge of how to order and interpret appropriate ancillary studies such as lab tests, and how to apply the results of arterial blood gas analysis. 10. Be familiar with the management of end of live issues. Practice Based Learning and Improvement: The student will 1. Complete assigned reading. 2. Identify knowledge gaps and seek out methods to correct. 3. Review medical literature specific to assigned patients. 4. Utilize online resources for reading assignments. 5. Identify indications for central venous access and invasive hemodynamic monitoring. Interpersonal and Communication skills: The student will be able to 1. 2. 3. 4. 5. Demonstrate basic ability obtain patient history. Discuss warning signs of complications. Participate and learn effective communication with the family members. Communicate patient information with other members of the health care team. Develop interpersonal and communication skills. Professionalism: The student will demonstrate 1. Ability to obtain informed consent. 2. Ability to maintain patient confidentiality. 3. Use professional judgment in caring for patients. 4. Function as a member of a surgical care team. 5. Be reliable and dependable for patient care. 6. Dress appropriately System Based Practice: The student will demonstrate the ability to: 1. Work effectively in various health care delivery settings and systems relevant to their clinical specialty. 2. Coordinate patient care within the health care system relevant to their clinical specialty. 3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or populationbased care as appropriate. 4. Advocate for quality patient care and optimal patient care systems. 5. Work in inter-professional teams to enhance patient safety and improve patient care quality. 6. Participate in the identification of system errors as part of performance improvement activities and contribute to the development and implementation of potential systems solutions. ASSESSMENT METHODS Mid Point Evaluation In accordance with LCME standard ED-30, the Course Director will evaluate student performance at mid-point to review the student’s professional, clinical and academic performance up to that point. The formative evaluation must be reviewed with the student and the student will have an opportunity to discuss with the Course Director. The form must be signed by the student and returned to the Course Director. The Course Director shall then forward a copy of the form to the Office of Academic Affairs. The form will NOT however be included in the student’s official academic record. Preceptor Evaluation- 100% Grading A= 90-100% B= 80-89% C= 70-79% F= below 70% The preceptors’ evaluation will be based upon, but are not limited to, the following factors: Attendance and participation in tutorials Conference attendance • Maturity and Professionalism • Oral Case Presentation/Patient Workup • Participation in call • The demonstration of basic knowledge of critically ill patient care. Successful completion of Institutional and Course Goals and Objectives 3 Evaluation of Course and Faculty Requirement Completion of evaluations of Course and Faculty members by students is a required component of this course. Students will be issued an “Incomplete” until the course and faculty evaluations have been submitted. DRESS CODE 1. 2. Students must wear appropriate attire when caring for patients, attending lectures, exams, conferences and case presentations. Appropriate attire includes: Clean shirt with ties (for males) Clean, white laboratory or clinic coat Clean, pressed trousers or skirts Identification name badge Polished shoes Identification name badge 3. The following items of dress are NOT ACCEPTABLE: Jeans Shorts or Capri’s Sandals, flip-flops, sneakers, tennis shoes, jogging shoes, Birkenstock, earth, open toe Low cut blouses or sweaters, midriff tops Skirts above the knee 4. Scrubs suits belong in the OR. They are not to be worn on the wards, except when emergency situations arise too quickly to permit changing clothes, or when returning to the OR immediately. On such occasions a clean laboratory coat must be worn over the suit. Shoe covers, hats & mask are NOT to be worn outside of the OR at any time. Scrub suits or portion of scrub suits are NOT to be worn outside the hospital for any reason. Hair is to be neatly cut & combed. Beards and mustaches are to be neatly trimmed. Students are to attend to their dress and personal hygiene at all times, including after a night on-call. Smoking: Cabell Huntington, St. Mary’s and the HVAMC are smoke free facilities. Smoking is only permitted in designated areas. 5. 6. 7. 8. 9. MUJCESOM Policies: All medical students taking this course will comply with School of Medicine policies given at http://musom.marshall.edu/students/policies. Individual policies can be found at the following websites: Student Infectious Material Exposure: http://musom.marshall.edu/ups/postexposure.asp MS-IV Attendance: https://musom.marshall.edu/students/documents/policies/Yr4attendence.pdf Academic Dishonesty Policy: https://musom.marshall.edu/students/documents/policies/Standards-of-Professionalism-and-Honor-Code.pdf Academic Standards Policy: https://musom.marshall.edu/students/documents/Policies/ASC-FINAL-POLICY.pdf Policy for Students with Disabilities: https://musom.marshall.edu/students/documents/Guidelines.pdf University Computing Services’ Acceptable Use Policy: http://www.marshall.edu/ucs/CS/accptuse.asp Affirmative Action Policy: pp. 16-17 http://www.marshall.edu/catalog/Graduate/S2008/gr_sp08.pdf Inclement Weather Policy: https://musom.marshall.edu/students/documents/policies/MUSOM-Inclement-Weather-Policy.pdf Notification of delays and cancellations of classes are posted on the Medical Education Home Page when Marshall University Main Campus is not in session https://musom.marshall.edu/weather Required Reading: To be assigned by Course Director Suggested Textbook: American Colleges of Surgeons ACS Surgical Text (Copy in SUR library) 5