STUDENT RESPONSIBILITIES FOR

CARDIAC SURGICAL SERVICE

Learning Objectives

1. Acquire knowledge in the following surgically-related problems:

Ischemic heart disease

Myocardial ischemia/infarction

Rheumatic valvular disease

Aortic stenosis

Myxomatous mitral valve disease

Cardiac insufficiency /shock

Invasive ICU monitoring

Cardiac tamponade

Hemo / pneumothorax

Pulmonary insufficiency

Renal insufficiency

Cardiac disrythmias


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2. Learn to write structured, focused history and physical examinations and progress notes.

3. Learn to efficiently evaluate post surgical patients and orally present findings, assessment and plan.

4. Develop Operating Room experience including:

· Proper scrubbing technique

· Participation at the operating table using aseptic technique

· Correlation of pathological findings with signs and symptoms of disease

5. Acquire patient exposure to refine bedside manner.

6. Refine technical skills including:

· Venipuncture

· Placement and removal of NG tubes and Foley catheters

· Dressing wounds and managing drains

· Basic suturing

Cardiothoracic Surgery Division (Organization)

Dr. Michael Mill serves as the Chief of the Division of Cardiothoracic Surgery. His clinical practice is focused on congenital heart disease. The attendings on the general Thoracic service are Dr. Richard Feins, Dr. Thomas Egan, Dr. Benjamin Haithcock and Dr. Nirmal Veeramachaneni. The attendings on the Adult Cardiac service are Drs. Michael Bowdish and Brett Sheridan. The medical student’s responsibilities on the cardiac service will focus on the adult cardiac section. The cardiothoracic fellow will have first line responsibility for mentoring the second year surgical residents and the medical students.

Clinics

Cardiac surgery clinic meets on Wednesday mornings at 10:00. New patients, postoperative follow-up evaluations, and preoperative referrals are seen. Student attendance is required. Most elective cases are admitted through this clinic.

History and Physical Workups

A major source of learning is obtained from new admission workups. Students are to obtain a complete history and perform a physical examination on all new admissions or patients seen in consultation who ultimately come to the surgical service for an operation or management. Occasionally, workups may be done during a clinic visit. New patient workups should be shared among students regarding number and diversity of disease processes.

Progress Notes

Students are expected to write daily progress notes on the patients they are following. These progress notes do not replace the housestaff notes. All progress notes should contain the pertinent subjective (S) and objective (O) findings, as well as a concise assessment (A) and plan (P). The Student Progress Note must be concise and pertinent. Lab data are recorded. Assessment and plans should be discussed with a physician before writing in the chart. Remember the chart is a legal record, and statements should show responsible thinking. A minimum of one Student Progress Note every day until discharge is required. The surgical house staff and Attending physician countersign Student Progress Notes and add comments, corrections, and additions.

The Student Progress Note should follow the format outlined:

Date Student Progress Note

PO Day # ______

S: Events and active complaints since last rounds

O: Vitals signs, I/Os including drains and tubes

Physical exam, focused

New labs

A: Concise list of active issues

P: Plan for each active issue

Operating Room Opportunities

Each student should have the gross pathology demonstrated to him/her in the operating room on all the patients he/she is following. Student operating room assignments will be decided the day before surgery to give each student ample opportunity to read and prepare for the particular case. It is expected that each student be familiar with each case on which they scrub. Students should make every effort to see the patients pre-op. At a minimum their chart should be reviewed. Although the student following an assigned patient is expected to scrub on that operation, other students are encouraged to view operations whenever possible during the rotation. All students are expected to be knowledgeable in operating room conduct. It is the student's responsibility to check on the time of the operative procedure so that he/she may plan his/her activities to be present.

On Call

Students are excused from “Call” while on this 2 week rotation. They are expected to remain for the course of the day until all cases are completed for the day and afternoon/evening rounds are concluded.

Orders

Students are to learn to write postoperative orders. This is done by observing the housestaff during computerized physician order entry. Proper organization of orders is a high priority. Knowledge of the correct dosage of medicine, proper laboratory tests, and nursing orders is necessary.

Conferences

There is an abundance of formal teaching sessions that meet on a regularly scheduled basis on Cardiothoracic Surgery. The students should attend as many of these sessions as possible. Priorities include:

1. Medical Student Lectures - 7:30 am Monday, Tuesday, Thursday; 8:30 am Wed, 8:00 am Friday - OR classroom

2. Surgery Grand Rounds - 7:15 am Wednesday, Clinic Auditorium

3. Thursday – 6:45 AM – CT Didactic Teaching Conference – Smith CT Education Center, 3rd Floor Burnett-Womack

4. Friday – 7:00 am OR classroom – Division preop / postop conference

5. Tutorials – As scheduled with Attending Physicians

Rounds

Early morning Work Rounds are conducted by the housestaff to determine any changes in each patient's condition and make decisions regarding management for the day. Students are responsible for keeping abreast of the clinical condition of their patients and decisions for management. It is expected that all patients will have been evaluated BEFORE morning attending rounds by students and/or housestaff.

Each morning formal attending rounds begin @ 6:30am in the CTICU. The Attending and Chief Resident supervise rounds with the housestaff and students. Questions and discussion are encouraged. Students should be able to present a brief, concise synopsis of the patient's problem and progress on rounds.

Afternoon rounds are scheduled for 5:00 pm in CTICU each weekday.

Evaluations

At the completion of each rotation, the attendings and housestaff meet to discuss the performance of the students. A consensus evaluation form is then submitted to the Surgery Clerkship Office usually within two weeks of the end of the rotation. Students are encouraged to meet with the Divsion Chief or other faculty members to review their evaluations.

9/23/2009

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