/ Department of Physician Assistant Studies
Learning. Caring. Serving. Leading.
PAS 638: Surgery
3 Semester Hours

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.

Course Director: / Office / Phone / E-mail
Diane Duffy, MD / FC 205 / 336-278-6848 /
Tracey Tonsor, PA-C / FC 207 / 336-278-6852 /

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, withthe 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.
  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.

Required Textbooks:

  • All first-year required textbooks.
  • Current Diagnosis & Treatment: Surgery, 13e

Other Resources:

  • *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.

Assessment Activities:

Exams/quizzes (30%), Preceptor Evaluation (60%), Professionalism (10%).

Grade Scale and Grade Points

Percentage / Letter Grade / Grade points
89.50-100
85.50-89.49
79.50-85.49
75.50-79.49
69.50-75.49
Below 69.50 / A
B+
B
C+
C
U / 4.0
3.3
3.0
2.3
2.0
0

There is no rounding of grades.

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
  2. 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.
  3. Perform and document appropriate physical examination for pre-operative screening and post-operative follow-up.
  4. Ensure proper pre-operative preparation of the patient.
  5. 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.
  6. Identify the appropriate and available diagnostic tests for a particular problem based on the history and physical examination findings.
  7. Identify and discuss indications and contraindications of diagnostic tests
  8. Identify and describe the risks, costs, and patient inconvenience of diagnostic tests.
  9. Demonstrate the skills required to collect routine specimens including bacteriologic samples, venous and arterial blood, sputum, and urine.
  10. 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:
  11. Pain management
  12. Perioperative antibiotic usage
  13. Chemotherapy
  14. Inpatient considerations (e.g. sleep medications, anti-emetics, laxatives)
  15. Discuss anesthetics, their indications, modes of action, contraindications, complications and combinations in:
  16. General anesthesia
  17. Spinal and regional anesthesia
  18. Regional anesthesia/field blocks
  19. 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.
  20. Recognize the signs and clinical manifestations of hypovolemia and hypervolemia and institute corrective measures.
  21. Practice proper technique in the following settings
  22. 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.
  23. Demonstrate ability to set up a sterile field outside the O.R. (for office procedures)
  24. Be competent in wound closure techniques
  25. Know the various techniques for dermal closure
  26. Discuss the different types of suture materials and their uses including silk, gut, chromic, nylon, Dacron and vicryl.
  27. Demonstrate ID of an abscess.
  28. 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.
  29. Present to the physician a brief synopsis of the patient’s illness, pertinent positive and negative findings and the diagnostic and therapeutic regimen instituted.
  30. Communicate effectively with the patient and family regarding the disease process, risks, expected outcome, possible side effects, and post-operative care.
  31. Document the care of the surgical patient
  32. Write clear, concise and relevant progress notes delineating diagnostic, therapeutic and patient education plans
  33. Dictate or otherwise document the discharge summary
  34. Maintain a complete up-to-date problem list
  35. Recognize signs and symptoms of common emergencies and take appropriate action to sustain life
  36. Apply basic techniques of CPR
  37. 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)
  38. Initiate hemostasis in a patient with hemorrhage
  39. Assess and treat hemorrhagic shock
  40. Be familiar with triage procedures in mass casualty situations.
  41. Assess patients with multiple trauma, skull and/or spinal injuries.
  42. 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.
  43. 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.
  44. Coordinate communication with the patient’s primary care and/or referring physician to allow for smooth transition of care.
  45. 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)
Care / Chest pain; history of angina / Cholangitis
Risk assessment: / Syncope / Hepatic carcinoma
Cardiac disease: history of , / Dyspnea on exertion / Pyloric stenosis
MI, unstable angina, valvular / Claudication / Acute/chronic cholecystitis
disease, hypertension / Aortic Aneurysm/dissection / Acute/chronic pancreatitis
arrhythmias, heart failure / Arterial embolism/thrombosis / Pancreatic carcinoma
Pulmonary disease: history / Peripheral arterial disease / Appendicitis
of asthma, COPD / Arterial/venous ulcer disease / Inflammatory bowel disease
Metabolic disease: history / Varicose veins / Small bowel carcinoma
of diabetes, adrenal / Gastrointestinal / Toxic megacolon
insufficiency / Abdominal pain / Colorectal carcinoma
Hematologic disease: history / Anorexia / Diverticular disease
clotting disorders, / Heartburn/dyspepsia / Bowel obstruction (small,
anticoagulant use / Nausea/vomiting / large, volvulus)
Tobacco use/dependence / Jaundice / Anal disease (fissures,
Substance abuse / Hematemesis / abscess, fistula)
Post-operative fever / Diarrhea/constipation/ / Hemorrhoids
Wound infections / obstipation/change in bowel / Hernias (inguinal, femoral,
Deep venous thrombosis / habits / incisional)
Fluid/volume disorders / Melena/hematochezia / Bariatric surgery
(volume overload/depletion) / Esophageal cancer / Pulmonology
Electrolyte disorders / Hiatal hernia / Shortness of breath
Acid/base disorders / Peptic ulcer disease / Hemoptysis
Hematologic System / Gastric cancer / Weight loss, fatigue
Easy bruising/bleeding / Pancreatic pseudocyst / Lung carcinoma
Anemia / Cholelithiasis / Pleural effusion
Fatigue / Choledocholithiasis / Pneumothorax
Pneumonia (post-operative)
Topics (cont’d)
Urology/Renal / Endocrinology / Dermatology
Edema / Tremors / Rash
Orthostatic hypotension / Fatigue / Redness/erythema
Urinary retention / Palpitations / Discharge
Dysuria / Heat/cold intolerance / Drug eruptions (post-
Fluid and electrolyte / Hyperparathyroidism / operative)
disorders / Hyperthyroidism / Urticaria (post-operative)
Testicular carcinoma / Thyroid nodules / Cellulitis
Wilm’s Tumor / Thyroid carcinoma / Burns
Bladder carcinoma / Adrenal carcinoma / Pressure ulcers
Renal cell carcinoma / Pheochromocytoma / Basal cell carcinoma
Chronic renal failure / Obstetrics/Gynecology / Squamous cell carcinoma
(shunts/access) / Pain / Melanoma
Renal vascular disease / Skin Changes / Neurology (Neurosurgery)
Nephrolithiasis / Nipple discharge / Change in vision
Acid/base disorders / Adenopathy / Change in speech
Benign breast disease / Motor and/or sensory loss
(fibroadenomas, fibrocystic / Vascular disorders (carotid
breast disease) / disease)
Breast carcinoma / Subarachnoid hemorrhage
Subdural hematoma
Epidural hematoma

Surgery Rotation Expectations

Successful completion of the Surgery rotation will be evidenced by:

  1. Completion of the 6 week Surgery rotation.
  2. Documentation in the Typhon database of a minimum of 75 patient encounters over the course of the rotation to include visits for conditions requiring surgical management in the following settings:
  3. Pre-operative care
  4. Intra-operative care
  5. Post-operative care
  6. Evaluation and treatment or self-study of the diagnoses listed in the Topic List of the Surgery syllabus.
  7. Completion of appropriate deliverable for Clinical Year Seminar (may include pre-operative note, SOAP note, or procedure note).
  8. Participation/observation and documentation of the following procedures, as available:
  9. Interpretation of chest x-ray
  10. Nasogastric tube placement
  11. Chest tube placement
  12. Thoracentesis
  13. Foley catheter placement
  14. Simple and complex suturing
  15. Stapling
  16. Endotracheal intubation
  17. Lumbar puncture
  18. Local anesthesia
  19. Have achieved a passing grade (69.5% or greater) for the course from the following assessments:
  20. End of Rotation exam
  21. Preceptor Evaluation
  22. Professional Assessment Tool
  23. Contacting Clinical Education Team at any point in rotation to discuss concerns regarding the ability to achieve the above.

Revised 1/15/16