Third Year Student Rotation – Oncology (C) Surgery Service - CHS
Students should page the intern on the C service before they begin the rotation to find out where and when to meet. The name of the intern and pager can be found on the R1 General Surgery rotation schedule located at the Surgery website:
Goals of Clinical Rotation
The overall goal of this rotation is to introduce you to the principles of evaluation and management of surgical oncology patients, with a special focus on sarcoma, melanoma, colorectal malignancies and breast disease. You will be participating in most of the activities in which the residents on the C Surgical Service partake. During the rotation, you will be expected to gain skills in the following areas:
A.Comprehensive evaluation of in-patients
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. This write-up will be placed on the chart, and it should be reviewed and countersigned by the Senior or Chief Resident on the Service, who will provide constructive criticism about its form and content. Patients who have been in the hospital prior to being assigned to you should still be evaluated by you, and you should place a write-up on the chart.
B.Focused evaluation of out-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. This will occur in the Revlon/UCLA Breast Center located on the B2 level in the 200 MedPlaza building. 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.
For both in-patients 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 formal and informal case presentations, etc.
C.Diagnostic aspects of surgical oncology diseases
By the end of the rotation, you should become familiar with a variety of diagnostic techniques peculiar to surgical oncology, and be aware of their indications, limitations, and risks. These include the use of CT scans and MRI to diagnose soft tissue and retroperitoneal tumors, lymphoscintigrams for evaluation of lymph nodes in patients with melanoma, and radiofrequency ablation for patients with hepatic metastases. In the BreastCenter, you should become familiar with mammograms and breast ultrasonography and the appropriate use of these modalities in the work-up of a patient with a breast mass.
D.Surgical treatment of oncology diseases
You should learn the basic principles of diagnosis and treatment of a variety of oncologic diseases including: sarcoma, melanoma, breast cancer, colorectal cancer, gastric cancer, and the treatment of hepatic metastases from colorectal cancer. This should include information about alternative forms of therapy, indications for surgical treatment, the basic principles of operative management of each, risks and complications of surgery, and chances for success. You should also acquire knowledge of sterile technique in and out of the operative room, and the basic principles of suture of surgical wounds.
E.Miscellaneous
There is an attending in the BreastCenter, Monday through Friday during morning and afternoon hours. Students should check with the third year resident on the C service to determine which clinics they should attend. All medical students should attend the Multidisciplinary Breast Conference every Wednesday afternoon from 1:00 pm to 4:30 pm in the BreastCenter.
In addition to all of the regularly scheduled Departmental and General Surgery Divisional lectures, conferences, etc. which medical students are expected to attend, attendance is required at the weekly C Surgery Journal Club which is held from 4-5 pm in the Mirabelle Library, Room 54-139, CHS. Students should check with the C Surgery Chief Resident for the journal articles to be discussed each week. In addition, all students should attend the Musculoskeletal Research Group Conference which is held Thursdays, from 4:30 pm to 5:30 pm in the Radiation Oncology Conference Room, 200 Medical Plaza, Level B2.
Dr. James Economou, Chief of Surgical Oncology, will meet with the students to discuss various oncologic topics during the course of the rotation. Each student will receive a reading syllabus, which covers most of the oncologic diseases that students will be exposed to during their rotation on C service.
On call schedule and weekend activities are variable according to caseload and the students' interest, and should be arranged with the Chief Resident on the C service.
Summary Sheet
Third Year Student Rotation – Surgical Oncology (C Service) -- CHS
Student Name: ______
Dates on Service: ______
Complete workups -- History and Physical Examination (patient name, diagnosis, date of H&P)
1. ______
2. ______
3. ______
Clinic Patient Notes:
1. ______
2. ______
3. ______
C Surgery Service clinical activities (these are OBLIGATORY, fill in date).
______1. Write postoperative orders with Attending or Resident supervision
______2. Examine abdomen with Attending or Resident supervision
______3. Place Foley catheter in Operating Room with supervision
______4. 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 (Observe operation)
1. Resection of a soft tissue sarcoma: ______
2. Colon Resection:______
3. Excision of a melanoma with sentinel lymph node dissection: ______
4. Radiofrequency ablation of hepatic metastases:______
5. Mastectomy or lumpectomy with sentinel lymph node dissection:______
Comments about rotation:
Please turn in this completed form to Iris Mau in Room 72-215 CHS.