Introduction / General Information

• Goals
• Objectives
• Clinical Role
• Skills and Procedures
• PDA's
• History and Physical Exams
• Student Performance and Due Process
• Texts and Manuals

Goals

The overall goals of the third year surgery clerkship are to assist the student in developing the following abilities and skills:

1. The practice of applying basic science disciplines to clinical situations.
2. To recognize diseases or conditions which are treated surgically. This includes understanding the normal physiology, pathophysiology and changes incurred by surgical treatment. The student will be expected to understand the natural history of surgical diseases, and the normal physiology in individuals not affected.
3. To develop problem solving skills based on a complete history, performance of a complete physical examination and collective interpretation of additional data such as laboratory and x-ray results.
4. To recognize common surgical emergencies and the appropriate responses to these emergencies.
5. To develop basic manual skills required in effective patient care.
6. To develop self assessment skills which will provide the student with appropriate input or awareness as to his/her performance on the clerkship objectives.
7. To develop and maintain personal characteristics, attitudes and ideals appropriate for the physician and surgeon. This should include an awareness of personal strengths, weaknesses, appearance, reliability, integrity, honesty and the ability to interrelate with other individuals.
8. To develop skills enabling an effective interaction with patients, colleagues, nurses and other health care professionals. This includes the development of communication skills which are necessary for the exchange of information concerning patients, and the ability to cooperate with other disciplines in patient care.

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Objectives

General objectives are inferred with the previously stated goals. Objectives for specific surgical subjects have been prepared by the Curriculum Committee of the Association for Surgical Education (ASE). The Manual of Surgical Objectives: A Symptom and Problem-Based Approach, 4th Edition. Manual of Surgical Objectives  These are essentially lists of expected knowledge, skills and accomplishments to be studied for each specific subject.

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Clinical Role

Surgical clerks assume a significant role on the surgical team with supervised responsibility in the care of all patients on the service. The student will perform a complete history and physical examination on each patient assigned, unless otherwise indicated by the attending surgeon. The student’s history and physical examination will be submitted to the preceptor for evaluation.

The surgical clerk is responsible for checking with the private attending surgeon and operating room for the time of scheduled surgical procedures. All clerks WILL be excused for assigned Seminars and Examinations. Also, all clerks will participate in scheduled teaching ward rounds which do not interfere with other responsibilities. These times will be designated on the weekly schedule. Attendance (in person or by video conference) at Surgery Grand Rounds and M and M conferences are mandatory and students will not be excused except for illness or other special circumstances.

Cardiothoracic surgery is incorporated into the eight week surgery rotation as a 2 week rotation.

The third year clerks rotating on Surgery will be evaluated on the basis of multiple experiences. The clerk is expected to work up 2 or more patients per week as assigned by preceptors. When assigned a patient with a specific surgical disease or condition, the clerk will be expected to be able to relate pertinent surgical information regarding the disease or condition at the end of the clerkship. Evaluation of the student's performance and cognitive skills will be accomplished through the use of objectives seminars, student case conferences, instructor ratings and by examinations as outlined in the Department of Surgery evaluation policy.

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Skills and Procedures

It is impossible to establish an all inclusive list of technical and procedural tasks performed by third year medical students. Backgrounds and previous experiences will vary, but all should have had some experience in performance of history and physical examinations, including pelvic and rectal examinations.

The following skills are part of the surgical clerkship experience and should be initially supervised prior to being performed independently:

1. Venipuncture for drawing of blood or initiation of IV's.
2. Change of dressings; advancement of drains; removal of sutures or staples.
3. Passage of nasogastric tubes.
4. Placement of urinary catheters (both male and female).

The following procedures are usually performed by house staff or attending staff, but on occasion, may be performed by students under direct supervision of a staff member:

1. Arterial puncture for obtaining blood gases.
2. Suture of minor lacerations.
3. Skin biopsy.
4. Thoracentesis.
5. Portions of surgical procedures.
6. Airway management.

The medical student must recognize that he/she is both ethically and legally responsible for the care that he/she delivers. Any procedure that he/she undertakes should have been previously discussed with and approved by either a house staff or attending staff member.

The medical student must recognize the patient's right to privacy and freedom from undue discomfort or injury. The procedure must be adequately explained to the patient, informing the patient of the need for, and likely results of, and possible discomforts involved in the procedure. Alternate approaches may have to be explained. The student should properly identify themselves to the patient. If the student is not successful in the performance of the procedure within a reasonable amount of time or without undue discomfort to the patient, he/she should withdraw and seek supervision or assistance.

The medical student should be aware that nursing personnel often have greater experience in the performance of some procedures than the student has. In most cases, nurses are available and willing to assist and instruct in some of the procedures.

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PDA's

PDA's will be used to record patients' diseases; operations witnessed and assisted; procedures, skills observed, assisted and performed. These must be recorded weekly and submitted to UNDSOMHS website.  These patient encounters will not be part of the grade; they will, however, be used as a critique of the individual's rotation and also during the oral examination. Failure to complete the patient encounters or to submit them as requested will result in an incomplete mark in surgery.

Each student is to keep track of endotracheal intubations ~ (date, patient name, attempts, +/- successful).

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History and Physical Exams

The written history and physical examination prepared by the surgical clinical clerk should follow the format in the UND Physical Diagnosis Course Handbook.

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Student Performance and Due Process

The Department of Surgery emphasizes the importance of academic honesty and responsibility by the student. The student is specifically referred to in Division II, Standards of Academic Conduct of the Faculty of Medicine. (Attachment A)

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Texts and Manuals

The required manuals are (most recent editions):

1. "The Manual of Surgical Objectives: A Symptom and Problem-Based Approach, 4th Edition, by the Association for Surgical Education 2001 Link provided by the Association for Surgical Education - The Manual of Surgical Objectives
2. "TEAM" (Trauma Evaluation and Management) Student Booklet from the American College of Surgeons - www.facs.org

Contact your Surgery Department Campus Office regarding required texts 1 & 2.

In preparation for the operating room:

• "Surgical Anatomy & Technique: A Pocket Manual" by John E. Skandalakis

Reference texts (most recent editions):

1. "Essentials of General Surgery" by Peter F. Lawrence (2007)
2. "Principles of Surgery" by Schwartz
3. "Textbook of Surgery" by Sabiston
4. "Mastery of Surgery" by Nyhus
5. "National Medical Series (NMS) for Independent Study" Surgery, by Jarrell and Carabasi, III
6. "Cope's Early Diagnosis of the Acute Abdomen" by William Silen
7. On-line sources available by UND Librarians

The choice of text is yours but we recommend one surgery text and "Cope's Early Diagnosis of the Acute Abdomen."

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07/2006