Student Responsibilities for Trauma/Critical Care (SRH)

Student Responsibilities for Trauma/Critical Care (SRH)

Learning Objectives

1. Acquire knowledge related to:

a) Trauma – resuscitation, evaluation and diagnosis, care of specific conditions, North Carolina trauma system

b) Surgical critical care including use of invasive lines, ventilator management, nutrition, sedation

c) Preoperative risk assessment and post operative complications

d) Acute abdomen including presentations related to peptic ulcer disease, biliary disease, large and small bowel obstruction, diverticular disease, appendicitis

e) Hernia

f) Miscellaneous other general surgical problems

2. Learn to efficiently evaluate surgical patients

3. Learn to write focused history and physical examinations and progress notes.

4. Learn effective oral patient presentation skills

5. Develop Operating Room experience including:

a) Proper scrub technique

b) Participation at the OR table

c) Correlation of pathological findings with signs and symptoms of disease

d) Understanding of operative decision-making

6. Understand the importance of multidisciplinary care and participate with RN’s, physical therapy, speech therapy, social work and members of the trauma program

7. Develop technical skills including:

a) Venipuncture

b) Placement and removal of NG tubes, foley catheters

c) Dressing wounds and managing drains

d) Basic suturing

SRH organization

Division of Trauma and Critical Care is responsible for all trauma evaluations and admissions. We are also one of three services performing adult general surgical procedures. We have 7 attendings including Drs. Charles, Dreesen, Marshall, Rich, Stafford, Goodwin, Walker. Our team also includes one fourth year resident, two PGY2s, two-three PGY1s, as well as rotating residents from Emergency Medicine and Physical Medicine. We also have an NP, Lissy Olivencia-Simmons. We also work with the Trauma Program which includes a Director, an Outreach coordinator, trauma registrars, an alcohol and other disease counselor. The senior residentss are responsible for the organization and function of the service and they will orient incoming students.

Student Responsibilities on SRH

Students play an important role on the service. They have responsibilities, first and foremost, to the patients they care for. They are also part of a team, with attendant responsibilities to their team members including fellow students, residents and attendings. Students learn about surgery through a combination of patient care, didactic teaching, reading, OR exposure, the composition of written and oral patient presentations.

Students are expected to know thoroughly, pre-round on, assemble data on, and present all patients that they admitted and all patients in whose operations they participated (up to a total of five patients at a time).

Students are also expected to play a lead role in maintaining the list of service patients. The interns on the service will show the students how to accomplish this task.

Operating Room

Students should decide the night before in conjunction with the chief resident which cases they will scrub on. They should read and prepare for their cases. Due to the nature of trauma and general surgery, the OR schedule changes frequently. This requires everyone, including the students to be flexible. Students should check the schedule at the OR front desk frequently and should work together to cover all the SRH service cases, unless they conflict with a mandatory meeting or conference. When students do have conferences, they are expected to be in OR up until & immediately after these conferences.

On Call

SRH students are on call as directed in the clerkship orientation materials. Each on-call student should notify the Resident On-Call where s/he can be reached.

Clinic

One students is expected to be in clinic on clinic days which are Tuesday mornings and all day Thursday (general surgery clinic). Students are expected to evaluate patients in clinic and then present these patients to either an attending or the chief resident. Presentations should include a basic history, physical, assessment and plan. Students are expected to be in appropriate attire for clinic & rounds daily.

History and Physical Workups

Each student is expected to write up two history and physical workups and turn them in to Dr. Dreesen in printed form. Patients may be written up when they present as red or yellow trauma admissions during the day or when the student is on call with either the trauma intern or the senior-in-house. You may also write up patients who are worked up in clinic and scheduled for surgery. You may also write up any general surgical admissions or consults that the service evaluates.

History and Physical workups should adhere to the following format:

Info source

Chief Complaint

HPI

PMH (med, surg, meds, allergies)

ROS (focus on pertinent positives and negatives)

Data

Problem List/Assessment

Plan

A critical task of the surgical student is to learn to formulate a surgical differential diagnosis and to choose tests and plans that allow one to sort out the differential. Your H and P should have a well thought out differential and plan.

Progress Notes

Students are expected to enter one progress note daily into WEBCIS Med student notes (please do this in the generic field) and forward the note to Dr. Dreesen.

Conferences

1. The department as a whole has a variety of lectures that are mandatory for students.

AM lecture series
Tutorials
Dr. Sheldon rounds
Dr. Meyer rounds
Departmental M and M at 500 Wed in OR classroom

2. The Division of Trauma and Critical Care also has conferences which you are expected to attend

Critical Care Conference – Monday Noon in BW 4050

b. Second and fourth Tuesdays 2-4 Trauma M and M BW 4050

c. Surgery pre-op conference 8:00 Thursday BW 4050

Evaluations

Mid-rotation feedback will be provided by faculty members at the two week point.

At the completion of each rotation, the attendings and housestaff discuss the performance of the students. A consensus evaluation form is submitted to the clerkship office.

We strongly seek feedback on this rotation and encourage students to thoughtfully fill out evaluation forms.

IF YOU ARE LOST

If you find that you do not know what you should be doing, ask your chief resident. While there are down times on this service, there is almost always something you could be / should be doing. Places you ought to be include:

1. The OR

2. Clinic

3. Seeing consults with the PGY2 resident

4. Assisting PGY1s with floor work, learning about the roles of the many allied health providers involved in care of the trauma pt

5. Working on procedures – ICU & OR provide frequent opportunities for drawing ABGs or placing PIVs or placing NGTs, etc.

6. Reading to prepare for your cases or reading about things you have seen on-call. This means reading STANDARD surgical texts, not simply test prep books.