Third Year Clerkship Surgery

Orientation: 2013-2014

David Chen, MD, FACS

WELCOME TO SURGERY!

I am personally excited to welcome each one of you. Dr. Busuttil, our Chairman of Surgery, and Dr. Tillou,Director of Surgical Education, and the entire Department are delighted you are here.

  • We know that most students will not become surgeons but all of you will deal with surgical patients, evaluate surgical problem, require surgical skills, and have patients, friends and loved ones that will eventually need surgery.
  • It is an exciting field and the most hands on experience that you will have with patients. There is nothing quite like it and I hope that each of you has a meaningful experience on service.
  • Hopefully, some of you will find it exciting and rewarding enough to become surgeons. For those of you that do, we are here to mentor you, foster your careers, and support you in your training.
  • The goal of this course is to provide general overview of Surgery- we want to be as relevant to future surgeons as to future primary care physicians, pathologists, dermatologists, etc.
  • This rotation will be challenging and rigorous but also stimulating, enjoyable, exciting, and fun.

We wish to provide insight into the various disciplines within Surgery

  • Includes both General Surgery and the Surgical specialties

The genesis of the course as it stands:

  • Review of past performance indicated that students were not achieving satisfactory standards in physical exam
  • Concerns as to the breadth of experience and the standardization of exposure
  • Concerns of student preparedness to begin the Surgery Rotation
  • Student preconceptions regarding Surgery
  • Our wish to set the table for the clerkship: to establish the ground rules and outline our expectations.
  • Hence the current structure: a combined Specialty Surgery and General Surgery clerkship with Orientation

Goals for this week:

  • Background information
  • Physical exam modules
  • Review of the Surgery Clerkship
  • Organization and Operational Plan

Goals for clerkship:

  • Broad based knowledge set
  • Clinical skill set
  • Physician skills

Who are we:

  • We are kinder, gentler people
  • The preconceptions of Surgery as malignant and surgeons as uncaring is an error
  • The culture of surgery: Challenging and Rigorous
  • Vertically integrated
  • Truth telling
  • Small margin for errors
  • Do’s and don’ts

Logistics (Important)

Web Case Log(

  • Imperative
  • Required to enter a minimum of 5 cases per week
  • Look at index cases (Core Problems)
  • Be sure to cover all topics in clinical experience or in Web based study(listed on ANGEL)

MiniCEX

  • Must be filled out by a faculty member during clerkship – one form for the 12 week clerkship
  • Any site or specialty
  • Focused or complete history and physical is acceptable
  • Submit by Week 8
  • Failure to complete will result in a grade of Incomplete for the clerkship

Site Feedback Form

  • Must be filled out by Site Director or designated faculty for each inpatient and specialty rotation

Grades

  • Clinical Grade
  • Practical Grade
  • Shelf exam

Evaluation System

  • My Courses
  • Site Director Feedback

LOD

  • LOD: 20%last year
  • Criteria: Excellence in Clinical, Practical, and Shelf Examination
  • Clinical: Uniformly Performance Exceeds Expectations to Outstanding PerformanceMy Courses Evaluationsfrom Residents and Faculty in all blocks (General and Specialty). Must receive a score of 4.5 in every category.
  • Practical: Excellent Performance. Must receive a score of 90 percent or above.
  • Shelf Exam: Consider those that score 85 or above (standardized score, not percentile)on the Surgery Subject Exam.

To understand what demonstrates an outstanding clinical performance, please see the descriptors listed below:

  • History taking: Precise, logical, thorough, reliable, purposeful, and focused. Includes all pertinent positives and negatives.
  • Physical examinations: Very complete, accurately done, directed toward patient's problem(s), and elicits subtle findings.
  • Case Presentations: Extremely clear, organized, complete, accurate, and polished presentation appropriate in length to the situation. Uses precise, accurate terminology.
  • Write ups: Outstanding, conscientious and accurate in recording patients' histories and physical exams. Differential diagnoses are extensive. Outstanding analysis of patient's problems. Therapeutic plans are thorough.
  • Medical Knowledge: Extensive, well-applied knowledge of disease, pathophysiology, diagnosis, and therapy. Consistently up to date. Familiar with relevant current journal articles.
  • Clinical Judgment: Regularly integrates medical facts and clinical data, weighs alternatives, costs, risks and benefits. Understands limitations of knowledge. Wise use of diagnostic and therapeutic procedures. Regularly applies evidence-based medicine.
  • Physician Patient Interactions: Does not use jargon. Communication with patients and families reflects clarity and empathy. Effective communicator with teams, staff et al.
  • Professional Attitude and Behavior: Enthusiastic, responsive, reliable. Committed, cooperative and respectful. Establishes trust. Displays initiative.

Failure

  • Failing grades in any of these three components will require remediation or repetition of the rotation depending on the circumstance

Books

  • A General Surgery Textbook
  • No one required text

Resources:

  • Netter's Surgical Anatomy Review: Robert B. Trelease, Ph.D. access through mednet VPN
  • Wise MD (18 modules). Required to Complete

Angel > Surgery Resources > Wise-MD online cases

Failure to complete the required modules will result in a grade of Incomplete for the clerkship

  • WebSurg: EU Site of Many Operations and Modules
  • MD Consult > Books > Khatri’s Operative Anatomy

Professionalism

Behavior

Attire

  • Look professional (including during orientation)
  • Change into Scrubs for cases
  • Students on Trauma will usually wears scrubs
  • When in doubt, ask your chief resident or attending

Attendance/ Absences

  • Must be accounted for
  • Report all absences to the resident on service and Iris

Educational Philosophy:

You must be a self learner:

  • Too much material to cover in didactics
  • You must read
  • We will present you with opportunities to see and learn
  • We provide Faculty and Residents who can expertly answer your questions and clarify issues
  • We provide an environment where Surgery – in all of its elements is available

We see each other as colleagues:

  • Professional basis for interaction: Courtesy, consideration, politeness
  • Respect both directions

Zero tolerance policies:

  • Abuse, disrespect, foul language, and behavior
  • Untruthfulness, cheating, LYING

Logistics
Days Off

  • Twenty eight hour limit for consecutive work hours
  • One day off per week on inpatient
  • On specialty – check with chief resident regarding weekend rounds
  • Students do not have the weekend off between inpatient rotations and transitioning to or from specialty rotations
  • Holidays – not all holidays are universally observed; confirm with your resident if there is clinic

Call duties

  • Varies with site. Check with your resident team and Site Director if call is expected

Duty Hours

  • Minimum 6 hours off between shifts

Wednesday Conferences

  • Required attendance at morning conference at CHS (excluding students on Harbor inpatient).
  • Cedars Continuity and non-continuity students will stay at Cedars for teleconferencing of student lectures. If services are not available, you are expected at Westwood for conference.

Orientation:

  • Introductory lectures and examination modules

Conclusions

  • I wish for us to interact as colleagues
  • I hope that everyone is exposed to and gets a flavor of Surgery as a culture and field
  • I hope that you are challenged
  • I hope you have fun

Iris Mau: Surgery Clerkship Coordinator

  • TEAM Trauma Module: February 7, Friday at Harbor-UCLA
  • Surgery Website – show where resident rotation, schedule, and pagers are listed
  • ANGEL – Goals and objectives folders