UCLA-SantaMonicaMedicalCenter

Introduction for 3rd Year Medical Student General Surgery Clerkship

General Information:

You will be assigned to the surgery team at UCLA-SantaMonicaHospital. During your time at Santa Monica, you will attend clinic and OR with various surgery attendings. The chief resident will provide guidance regarding which attending you should work with on a given day, each student should work with as many attendings as possible in order to maximize the types of surgical problems seen and allow comprehensive and constructive feedback. In addition you will participate in inpatient rounds and consult evaluations with the general surgery team of residents.

First Day of Rotation:

Students should page the chief resident on the General Surgery service at UCLA-SantaMonicaHospital prior to starting to find out where and when to meet for rounds on your first day. The name of the chief resident and pager can be found on the R5 General Surgery rotation schedule located at the Surgery website: The UCLA-Santa Monica general surgery clinic and offices are located at 1304 15th Street, Suite 213. This is on the southwest corner of 15th and Arizona. The office phone number is 310-319-4080. The hospital main entrance is on 15th street, between Wilshire and Arizona.

ID badges must be worn at all times while in the hospital.

Call:

You will be responsible for taking call once or twice per week during your time at UCLA-SantaMonicaHospital. Call is taken from home. Details of the nights you will take call can be decided with the Chief resident once your start the rotation. In general, you should plan on taking call with either the senior or chief resident in order to maximize the educational benefit of evaluating new consults.

Parking:

Prior to beginning the rotation you should arrange to pick up a SMH parking pass from Iris Mau in the Surgery Education Office in room 72-215 CHS. Parking passes must be returned on the last day of the rotation. Failure to do so will result in an incomplete grade.

Questions or concerns:

Questions, concerns or issues with the rotation should be addressed to Dr. Foster at the office number above or via email . Verbal feedback and suggestions for improvement of the rotation is always encouraged and appreciated. If you are unable to come to the hospital for any reason, notify Dr. Foster or the chief resident on the service.

Conferences

In addition to Santa Monica specific conferences, you are expected to attend the weekly Wednesday morning conferences at UCLA from 7am-9am, located in 73-105 CHS and Core Lecture from 9am-10am in room 23-105 CHS.

Goals of the Rotation

  1. Comprehensive evaluation of new inpatients or consults

This begins with skill in performing a comprehensive history and physical examination (H&P). Practice in physical assessment and writing a well-organized and succinct H&P is important. Unlike the H&P's performed by the residents, which are often focused and limited in length, yours' should be more detailed and complete. The senior or Chief Resident on the Service, who will provide constructive criticism about its form and content, will review this write-up. The patient’s attending should also review each H&P individually with you. Patients who have been in the hospital prior to being assigned to you should still be evaluated by you.

  1. Focused evaluation of clinic patients

A separate skill from those just described for the in-patient is the ability to focus on a patient's specific problem in the outpatient setting. The H&P should be problem specific, and the written note should be succinct, brief, and focused when the patient is returning for a follow-up visit for an ongoing problem. However, when new patients are seen in the outpatient setting who later will undergo surgery, a comprehensive H&P is still required. This is because most patients will not be seen again until the day that the surgery is performed, and a complete evaluation is necessary before that time. When it is possible, you should follow the same patient who is seen by you in the outpatient clinic, when he (she) has an operation.

  1. Oral presentation of patients

For both inpatients and outpatients, you will also begin to develop skills in the succinct oral presentation of the pertinent points of the H&P to the residents and attending faculty. These opportunities will arise on daily resident rounds, and in the clinic.

  1. Develop an understanding of surgical diseases* and their treatment including:
  1. Breast – Evaluation of a palpable mass, evaluation of mammogram abnormalities, treatment and follow-up of benign and malignant breast disease
  2. Hernia – Diagnosis and surgical treatment of groin, ventral and incisional hernias.
  3. Anorectal – Understand how to perform a complete anorectal exam, treatment of benign anorectal disease including hemorrhoids, fissures, abscesses and fistulas.
  4. Appendicitis – Diagnosis and surgical management.
  5. Colon – Diagnosis and management of colon cancer and diverticulitis.
  6. Biliary Tract – Understanding, diagnosis and treatment of biliary colic, acute cholecystitis, and choledocholithiasis. Understand potential complications of cholelithiasis.
  7. Skin and Soft tissue – Basic principles for treatment of skin and soft tissues lesions by surgery.

*The specific problems and diagnosis you will have direct experience with will vary depending on your rotation. The above list should serve as a general guideline for common surgical diseases you may encounter.

Requirements/Expectations

1.A comprehensive H&P on at least one inpatient or consult per week. Give a copy of each of your H&P’s to the chief resident and to the attending.

2.Daily progress notes on the inpatients and inpatient consults you are following.

Usually this would be all of the inpatients of your assigned attending, but do not

follow more than four patients at one time, in order to maximize you learning from

each individual patient. All progress notes must be co-signed by either the chief resident, senior resident or attending.

3.Learn to write post-op and admission orders under attending or resident

supervision. Again, orders must be co-signed by senior or chief resident or by attending.

  1. Gain experience with techniques of NGT placement, foley catheter placement, incision and drainage, closure of skin incisions.

5. Complete attached summary sheet and return to Iris Mau at the end of the rotation.

Summary Sheet

Third Year Student Rotation – GENERAL SURGERY – UCLA Santa monica

Student Name: ______Dates on Service: ______

Attendings worked with:

1.______

2. ______

3. ______

4. ______

Complete workups -- History and Physical Examination (patient name, diagnosis, date of H&P)

1. ______

2. ______

3. ______

4. ______

Surgery clinical activities (fill in date).

______1. Write postoperative orders with Attending or Resident supervision

______2. Examine abdomen with Attending or Resident supervision

______3. Pass NG tube in Operating Room or on Ward with supervision

______4. Place Foley catheter in Operating Room with supervision

______5. Close skin of surgical wound with supervision

We would like you to observe the following index cases. We recognize that it may not always be possible. Check off if you were able to do the following:

Index Cases to See# Observed operations

1. Laparoscopic Cholecystectomy: ______

2. Colon Resection:______

3. Inguinal Hernia Repair: ______

4. Breast Surgery______

Comments about rotation:

Please turn in this completed form to Iris Mau in Room 72-215 CHS.