SURGERY CLERKSHIP - drcolquitt.com

SURGERY CLERKSHIPYEAR THREE | CLASS OF 2022

MACON | SAVANNAH | COLUMBUS

medicine.mercer.edu

Class of 2022,

On behalf of surgical departments across all three campuses. I would like to welcome you to the General Surgery Clerkship. We are committed to medical student education and continuously strive to improve your educational experience. The clerkship will introduce you to a wide variety of surgical diseases. You will have the opportunity to follow patients from their initial presentation to the resolution of their disease process. Teaching will occur in the operating room, clinics, wards, conferences, and lectures. You will also be expected to engage in self-directed learning on a daily basis. The faculty and residents are here to guide you and our goal is for the clerkship to be a meaningful and enjoyable experience.

I AM certain that many of you have some anxiety regarding your performance on this rotation. This is not a new phenomenon. Traditionally, the surgical clerkship has been one of the more challenging rotations, but it can also be one of the most rewarding. For many of you, this may be your only significant exposure to surgical concepts during your training. Others may elect to enter a career in surgery. Regardless of your anticipated career path, I encourage each of you to approach this rotation with dedication and enthusiasm. Your efforts will not go unnoticed.

Directors, Faculty, Residents and Staff Department of Surgery

WELCOME

Important Clerkship Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Clerkship Goals and Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

WiseMD Learning Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Curricular Expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Required Clinical Experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Evaluation Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Remediation Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

MUSM Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Appendix A: Campus Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Appendix B: Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Appendix C: Learning Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Appendix D: Clerkship Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Appendix E: Work Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

TABLE OF CONTENTS

YEAR 3 SURGERY CLERKSHIP | CLASS OF 2022 1

IMPORTANT SURGERY CLERKSHIP DATES

Rotation Start Date End Date Mid-rotation Exam Shelf Exam Holidays

Rotation 1 8/3/20 (orientation) 9/25/20 8/28/20 9/25/20 Labor Day (9/7/20)

Rotation 2 9/28/20 (orientation) 11/20/20 10/23/20 11/20/20 None

Rotation 3 11/23/20 (orientation) 1/29/21 12/18/20 1/29/21 Thanksgiving (11/26/20-11/27/20)Christmas Break (12/24/20-1/1/21)MLK (1/18/21)

Rotation 4 2/1/21 (orientation) 3/26/21 2/26/21 3/26/21 None

Rotation 5 3/29/21 (orientation) 5/21/21 4/23/21 5/21/21 Good Friday (4/2/21)

Rotation 6 5/24/21 (orientation) 7/16/21 6/18/21 7/16/21 Memorial Day (5/31/21)Independence Day (7/5/21)


CLERKSHIP GOALS AND OBJECTIVES

Definition: A goal is an outcome you intend to achieve, whereas an objective is an action that helps you achieve a goal.

Note: In the following text, the terms “clerk,” “student,” and “medical student” are synonymous.

Surgery Clerkship Goals• To initiate an exposure to the disciplines of surgery.

• To teach the surgical clerks to obtain the cognitive knowledge and clinical competencies to recognize patients need for surgical consultation.

• To prepare a differential diagnosis derived from the clinical history and physical findings.

• To identify the necessary diagnostic tools to identify the diagnosis and be able to have a preliminary plan of management.

• To socialize medical students into the best of culture of medicine such that they develop an enduring commitment to compassionate care of patients and life-long learning

• To promote improved communication skills between medical students and their patients, their patient’s family, members of the surgical team, and members of the broader interdisciplinary/interprofessional health care team.

• To develop a professional attitude and practice necessary for being a physician.

Settings:• The clinical settings include classroom activities, outpatient clinical patient exposure, the operating room, the recovery room,

the intensive care unit and the wards. It is expected that the surgical clerks will learn about the recognition of disease that a primary care physician would learn to recognize, so that the appropriate surgical consultation may be made.

Expectations: • The clinical clerks are expected to log their patient encounters into One45. These will be printed by the coordinator on a

weekly basis and reviewed by the director.

• The clerks will turn in a history and physicals and/or SOAP note to the coordinator every Monday to be reviewed by the clerkship director.

• The director will give feedback if the history and physicals are not written adequately.

• The clerks are expected to be an integral part of the surgical team to which they have been assigned, they will report to the intern resident and follow them closely.

• A limited night call experience is expected five (5) to six (6) times in a two-month period.

• The clerks must attend all post-graduate conferences and attend all didactic sessions that are provided for them. The didactic sessions are taught by attending surgeons from the Department of Surgery. There are also didactic, interactive discussions provided by surgical specialists in the areas of neurosurgery, orthopedics, and urology.

• The clerks are expected to be professional, compassionate, and altruistic with an appropriate attitude, all of which are carefully observed.

The faculty will strive to achieve these goals in the following manner: • Teach and model an approach to the evaluation and initial management of acute presentations commonly seen in surgical

patients in the outpatient and inpatient settings.

• Provide instruction in historical assessment, communication, physical examination, and clinical reasoning skills as pertains to surgical care and problem solving.

At the end of the surgery clerkship, each student should be able to:• Effectively and competently evaluate a patient and produce a competent history and physical that facilitates differential

diagnosis and the development of a treatment plan.

• Achieve the core basic knowledge that is considered necessary to the practice of medicine in surgical patients.

• Begin developing through behaviors professionalism skills which will encourage the development of an enduring commitment to the care of patients and the inter-and intra-professional teamwork this requires.

• Manage post op visits with patients having one or more common surgically related diseases.

We will assess the student based on completion of curricular components, faculty appraisal, and standardized National Board of Medical Examiners (NBME) testing.


Clinical Practice, Learning ObjectivesBy the end of the clerkship, surgery clerks should be able to:

I. Surgery Patient Care

Students must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Student will:

1. Become an integral part of the surgery team providing clinical care to the patient.

2. Demonstrate patient cares skills for diagnosis and management of patients.

3. Be directly observed by faculty members while performing of history and physical examination.

4. Submit write-ups of the history and physical examination of new patients.

5. Submit quality Progress notes.

6. Perform the required procedure skills.

7. Participate in the bedside rounds with team residents and attendings.

8. Give solid oral presentations.

Demonstration of patient cares skills for diagnosis and management of patients is assessed by one or all of the following: faculty assessments of clinical work and the NBME surgery shelf exam.

II. Surgery Medical Knowledge

Students must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Students will:

1. Develop an in-depth knowledge of the diseases in patients who require surgical evaluation.

2. Approach clinical decision-making in an evidence based, cost conscious manner that utilizes the principles of surgical medicine.

Demonstration of medical knowledge is through faculty assessments and NBME shelf examination.

III.Surgery Practice-Based Learning and Improvement

Students must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence. Students will:

1. Access sources of information at the point of care and interpret and use this data in real time.

2. Reflect on lessons learned from a patient seen for multiple visits.

3. Practice self-directed learning.

Demonstration of practice-based learning and improvement is through faculty assessments and NBME shelf examination.

IV. Surgery Interpersonal and Communication Skills

Students must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Student will:

1. Discuss the risk/benefit/nature of an operation with patients and families in the setting of informed consent.

2. Communicate evidence-based treatment plans to patients, and when appropriate to the patient’s family.

3. Communicate effectively with an interprofessional, surgical team.

4. Participate in the transition of patient care, i.e. “sign out.”

5. Communicate with consultants and nursing staff.

6. Be able to have end-of-life discussions.

7. Communicate effectively, using an interpreter when necessary, with patients of a different culture or language.

8. Accurately present patient findings to a supervising physician.

9. Accurately and completely chart patients. Use the SOAP format for current problems, problem list, medication list, and/or post op flow sheets

Demonstration of interprofessional and communication skills is assessed through faculty assessments.




V. Surgery Professionalism

We expect students to demonstrate the following:

• Compassion, integrity, and respect for others

• Responsiveness to patient needs that supersedes self-interest

• Respect for patient privacy and autonomy;

• Accountability to patients, society and the profession; and,

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

• High standards of ethical behavior, and

• A commitment to continuity of patient care.

Students will:

1. Consistently behave in a manner consistent with the Student Code of Ethics and Professional Conduct.

2. Consistently show respect for patient’s dignity and rights, including confidentiality.

3. Consistently display honesty and ethical behavior.

4. Consistently demonstrate dependability by being punctual and reliable.

5. Provide quality of care irrespective of race, ethnicity, sexual orientation, gender identity, culture, or religion.

6. Accept and provide constructive feedback to/from community faculty, staff, patients, peers, and course director.

9. Establish proper boundaries with students, staff, faculty, patients, and families of patients.

10. Recognize own limitations and seek opportunities to learn and to grow.

Demonstration of this goal is demonstrated by faculty assessment of adherence to ethical principles.

Breaches of ethical or professional behavior are identified through reports from clerkship directors and faculty as well as other clinicians and students. All breaches are reported to the dean of students and to the dean of the medical school. Formal action such as a professionalism project, a letter of censure or expulsion is rare. Such decisions are made by the dean of the medical school in consultation with the Student Professionalism Committee.

VI. Surgery Systems-Based Practice

Students must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Students will:

1. Identify and evaluate the psychosocial, cultural, familial and community influences that impact a person’s health.

2. Make positive contributions to patient care by working collaboratively with office staff, community faculty, and patients.

3. Apply public health principles and quality improvement methods to improve population health.

Demonstration of achieving this goal is by faculty assessment of clerks.

Detailed MUSM core competencies are in the MUSM Year 3 Handbook on Canvas.



Surgery Specific Learning ObjectivesTOPIC 1: Electrolyte Imbalance1. Be able to physiologic changes in common electrolyte imbalance to include:

• Composition of body fluids

• Daily maintenance of fluid requirements

• Control of essential body fluids

• Recognize signs of dehydration

Manage:

• Hyper & hypo Natremia

• Hyper & hypo Calcemia

• Hyper & hypo magnesium

• Hyper & hypo phosphatemia

• Recognize and manage:

• Acidosis, alkalosis, metabolic and respiratory

TOPIC: Abdominal Trauma1. Recognize, define, and diagnose blunt abdominal and penetrating abdominal trauma to include:

• Common physical findings

• A FAST EXAM

• A DPL

2. Outline a plan of management penetrating and blunt force injury

TOPIC: Shock1. Be able to describe and classify common shock states and list the common mechanisms of shock. Include treatment or

management plans for each of the following:

• Definition/classify, thermodynamics of perfusion pressure

• Hypovolemic states

• Inflammatory or septic shock

• Neurogenic shock

• Cardiogenic shock

2. Be able to describe:

• Acidosis

• Coagulopathic shock states

3. Describe the “bodies” ability to maintain homeostasis and “constant milieu” in shock like states

4. Be able to define:

• Preload

• After load

• Vascular resistance

5. Understand and recognize the components of physiologic monitoring.

6. The student should be oriented to the trauma unit in the emergency room.


7. Understand the principles underlying the “A, B, C’s” of trauma management to include:

• Airway management

• Circulation

• Resuscitation

• Initial management & treatment

8. Be oriented to the “Trauma Bay” to include:

• Physiologic monitoring

• Bedside procedures

TOPIC: Post-op Complications1. Be familiar with and be able to list and manage “Common post-operative complications” to include:

• Post-op fever

• Blood loss

• Electrolyte imbalance

• Airway complications

TOPIC: Acute Abdomen 1. The student should recognize the signs and symptoms related to the acute abdomen.

TOPIC: Hernia1. The student will recognize by history and physical diagnose the following hernias:

• Direct

• Indirect

• Femoral

• Richter’s

• Incisional

• Sliding

• Incarcerated

• Strangulated

• Reducible

• Irreducible

2. And be able to outline an operative plan for each.

TOPIC: Thoracic Surgery1. Define, diagnose, and discuss the common surgical conditions of the Thoracic Cavity including:

• Trauma

• COPD

• Pneumonias

• Tumors:

a. 1° squamous

b. Adenocarcinoma

c. Anaplastic Cancer

d. Oatcell Cancer

e. Carcinoid Cancer



TOPIC: Melanoma1. Recognize, diagnose and then discuss the principles in the management of benign and malignant melanoma. Student shall be

able to:

• Describe the A, B, C, and D’s of melanoma

• Outline statistics of and describe microscopic features.

• Explain biopsy procedures.

• Explain importance of depth of tumor to the surgical margin required.

• Explain the role of the sentinel node in management of malignant melanoma

TOPIC: Fractures 1. Be able to recognize common fractures and the basic principles of fracture management.

TOPIC: Burns1. Student will be able to:

• Know the rule of Nines

• Describe the Parkland formula

• Describe the rule of Nines in infants

• Define:

a. 1° burns

b. 2° burns

c. 3° burns

• Discuss short term and long-term complications of burns.

• Outline signs and symptoms of “burn” to the lungs.

• Define:

a. Burn Eschar

b. Biologic dressings in burns

• Define, diagnose, and discuss the principles of the management of burns.

TOPIC: Liver, Gallbladder and Pancreas1. Define:

• Hepatitis

• Cholecystitis

• Pancreatitis

2. Work up for the three disease processes above

3. Understand the consequences of a stone in the common duct

4. Diagnose acute cholangitis

5. Classify Pancreatitis

6. Manage acute pancreatitis

7. Work up a patient with a suspected pancreatic cancer

8. Define a Pseudocyst, acute and chronic



TOPIC: Thyroid & Parathyroid1. Be able to discuss the recognition of the surgical diseases of the thyroid and the parathyroid.

2. Classify Thyroiditis

3. Define a thyroid goiter

4. Diagnose:

• Hyperthyroidism

• Hypothyroidism

5. Classify & stage thyroid cancer

6. Define and classify 1°, 2°, 3° hyperparathyroidism

7. Outline a workup for hypercalcemia

8. Describe the anatomy of the parathyroid glands

9. Outline indications for parathyroidectomy

10. Describe the role of parathyroid hormone

11. Be able to review the proper steps in the diagnosis and the management of masses in the neck, and the management of infectious airway conditions.

TOPIC: Stomach and duodenum1. Review the principles in the management of the upper G.I. tract, bleeding, and peptic ulcer disease.

• Upper GI bleeding

• Gastric ulcer

• Duodenal ulcer

• Perforated ulcer

• Include indications for operative and conservative management

• Describe the role of H. Pylori in ulcer disease

2. Discuss the management of Boerhaave Syndrome, Mallory-Weiss Syndrome and Pyloric Stenosis.

3. Discuss the role of gastric cancer with a gastric ulcer

TOPIC: Small Bowel1. SBO

2. Regional Ileitis/Crohn’s Disease

3. TB of the small bowel

4. Lymphoma of the small bowel

5. Describe the diagnosis and management for acute appendicitis

6. Describe “An Ileus” and management thereof.

7. Define a Meckel’s Diverticulum

8. Define causes and management of small bowel fistula.

9. Define and manage “carcinoid” of the small bow



TOPIC: Colon and Rectum1. Recognize and diagnose

• Ulcerative colitis

2. Diagnose

• Diverticulosis, diverticulitis

3. Complications of and management of complications

4. Colorectal cancer

• Statistics of

• Diagnosis and classify and stage

5. Relationship of polyps to cancer

6. Describe:

• Hemorrhoids

• Fissure in ano

• Describe Sigmoid Volvulus

TOPIC: Colorectal1. Define:

• Colostomy

• Hartman’s Procedure

• Abdominal perineal resection

• Rectal cancer

2. Define

• Stage

• Overview of surgical management

TOPIC: Breast1. Student will be able to:

• Define basic anatomy of the breast and axilla

• Define Cooper’s ligament

• Diagnose common benign conditions

a. Fibrocystic disease

b. Cysts

c. Fibroadenoma

d. Intraductal papilloma

e. Breast infections

• Outline risk factors in and for malignancy

• Classify tumors

• Stage tumors

• Outline treatment options.

• Outline management of the axilla.

• Define “Sentinel lymph” node biopsy and its use in the management of breast cancer

• Define Paget’s disease and Phylloides tumors of the breast




TOPIC: Neurosurgery 1. The student should understand the basic principles of the neurological examination as it relates to the diagnosis of:

• Intra cranial, sub-dural and epidural hemorrhages

• Basic principles underlying the evaluation of blunt head trauma in terms of The Glasgow Coma scale.

TOPIC: Surgical Nutrition1. Student shall be able to:

• Know basic caloric requirement

• Fluid requirements/ 24 hours

• Define TPN

2 Outline requirement of:

• Protein

• Carbohydrates

• Calories/kg

• Fats

3. Define Respiratory quotient, R/Q

4. Outline special situations for nutrition in:

• Renal failure

• Respiratory failure

• Diabetic surgical patient

TOPIC: Hemostasis/Blood Products1. The Student will do as follows:

• Explain the “Simple Clotting Cascade”

• Describe Platelet functions

• List the major clotting components of fresh frozen plasma

• List the physiologic properties of the red blood cell

2. The Student should be able to identify the following blood diseases with the appropriate lab studies:

• I.T.P.

• Platelet dysfunction

• Lymphoma

• Multiple Myeloma

• Leukemia

3. The Student must identify Coumadin function in the clotting cascade.

4. The Student must identify Heparin function in the clotting cascade.

5. The Student must identify what low molecular weight heparin acts in the clotting cascade.

TOPIC: E.N.T.1. The Student shall identify the regions of the neck to include:

• Triangles of the neck

• Zones of the neck

• Nerves running through the neck

• Explain triple Endoscopy,

• Explain the indications for a radical neck dissection.

• List the indications for a tonsillectomy.



TOPIC: Surgical Infections 1. Identify Basic Antibiotic Coverage for infections:

• Appendicitis

• Ruptured/Diverticulitis

• Fecal soilage of peritoneum

• Prophylactic antibiotics in large bowel disease

• Bowel Prep

2. Process for choosing an antibiotic for a wound infection from GI Surgery.

3. Identify which antibiotic should be used for a ruptured viscus.

4. Be able to recognize the use and misuse of antibiotics in the management of common surgical infections.

TOPIC: Orthopedics1. The Student must be able to recognize common fractures and the basic principles of fracture management and management of

orthopedic emergencies

TOPIC: Genitourinary (GU)1. The Student should be able to:

• Understand and define basic anatomy of the genitourinary system.

• Diagnose BPH

• Work up a suspected Prostatic cancer

• Define the role of a P.S.A.

• Understand the treatment options for Prostatic cancer

• Classify transitional cell cancer of the bladder

2. Define a “hypernephroma”

3. Manage a case of severe urinary tract infection

TOPIC: Radiological Imaging1. The student will learn to recognize common pathological conditions/findings using diagnostic imaging studies appropriate for

the clerkship

TOPIC: Medical Legal Issues1. The Student shall identify:

• Standard of care breach

• Define medical negligence

• Define a Tort

2. Explain the Basic steps on a legal action against a physician

• Define “discovery”

3. List the steps to “avoid” medical malpractice litigation.



Clinic Cognitive ObjectivesClerkship: Surgery

Academic Period: 2020-2021

Directors: Jim Majors, MD (Columbus), Danny Vaughn, MD (Macon), and Mark Hamrick, MD (Savannah)

Objectives:

• The student should understand the principles of the ABC’s of trauma

• The student should recognize the signs and symptoms related to the acute abdomen.

• Recognize and treat electrolyte imbalance

• Be able to list the mechanisms of shock.

• Understand and recognize the components of physiologic monitoring.

• The student should be oriented to the trauma unit in the emergency room.

• The student should be able to list and manage the commonest surgical complications.

• The student shall define and understand the anatomy of the common hernias.

• Recognize the most common of surgical disorders of the small intestine and institute appropriate treatment.

• Be able to discuss the basic principles of diagnoses and the treatment of blunt and penetrating abdominal and chest trauma.

• Recognize, diagnose and then discuss the principles in the management of benign and malignant melanoma.

• Be able to recognize common fractures and the basic principles of fracture management.

• Define, diagnose, and discuss the principles of the management of burns.

• Diagnose and discuss the principles of management of common surgical conditions of the liver and gall bladder.

• Define, diagnose, and discuss the common surgical conditions of the thoracic cavity including:

- Trauma

- COPD

- Pneumonias

- Tumors

• Define, diagnose, and manage the surgical conditions of the breast including:

- Tumors

- Trauma

- Infections

• Be able to recognize the use and misuse of antibiotics in the management of common surgical infections.

• Be able to discuss the recognition of the surgical diseases of the thyroid and the parathyroid.

• Be able to review the proper steps in the diagnosis and the management of masses in the neck, and the management of infectious airway conditions.

• Review the principles in the management of the upper G.I. tract, bleeding, & peptic ulcer disease.

• The student should understand the basic principles of the neurological examination as it relates to the diagnosis of intra cranial, sub-dural and epidural hemorrhages, and basic principles underlying the evaluation of blunt head trauma in terms of The Glasgow Coma scale.

• The student should understand the basic principles in the management of surgical nutrition.



Common Competency(s)• The ability to do a surgical history & physical, make a reasonable diagnosis and outline a reasonable management plan of the

surgical conditions.

• The student should gain the technical experience to be able to close a simple laceration, put in sutures, and be able to put in and remove staples.

• The student should be able to outline a plan of action for the management of surgical infections, with either surgery or a plan for antibiotics.

• The student should be able to evaluate the laboratory data and images to predict physical signs that result in reasonable, predictable diagnosis.

• The student should be able to evaluate a trauma victim as per the ATLS manual and ABC’s of trauma

• Students should be able to outline a reasonable plan of action meeting the general standards of care of blunt force trauma and to make a diagnosis.

Evaluation Method(s)In the evaluation of the surgical objectives and the clinical competencies, these competencies are evaluated in many different ways, and not all of the evaluative tools are utilized during the experience gained in getting a clinical competence.

What follows are the evaluative tools used by the faculty to be sure that the student has reached these objectives.

a.) There will be direct observation of student performance of all the clinical competencies.

b.) Student case presentations and communicative skills shall be evaluated by the faculty and the resident staff.

c.) The resident and faculty staff will observe the clinical clerks while in the operating room.

d.) The clinical cognitive objectives are evaluated by the Shelf Test of the National Board of Medical Examiners in Surgery.

e.) The National Board of Medical Examiners Part II for cognitive knowledge book of multiple-choice questions.

f.) There are interactive group discussions with the residents and faculty with the medical students.

g.) The student’s clinical skills are then evaluated by the resident and faculty staff, which then becomes part of the clinical skills evaluation.


WISEMD LEARNING OBJECTIVES

Appendicitis

Module Goal:The purpose of this module is to review the presentation and findings associated with acute appendicitis as well as other pathophysiologic entities in the right lower quadrant and introduce students to the process of clinical reasoning and the central importance of the patient interview to generating and narrowing the differential diagnosis.

Fundamentals:1. To describe the process of clinical reasoning and the central importance of the patient interview to generating and narrowing

the differential diagnosis.

Bariatric

Module Goal:At the end of this module you will be able to describe the aspects of morbid obesity and the surgical options for weight loss and the control of weight related co-morbidities.

Fundamentals:1. To define obesity.

2. To understand the health consequences of obesity.

Bowel Obstruction

Module Goal:At the end of this module you will be able to understand about the presentation, diagnosis and management of small bowel obstruction and how to distinguish this from ileus or large bowel obstruction and list the common etiologies of bowel obstruction.

Fundamentals:1. To list the common etiologies of bowel obstruction.

Burn Management

Module Goal:At the end of this module, you will be able to explain the etiology and pathophysiology of thermal injury and the initial evaluation, diagnosis, and management of burn injury and its complications, list 3 important advances in burn care and describe the multidisciplinary burn team.

Fundamentals:1. To list three important advances in burn care.

2. To describe the multidisciplinary burn team.

3. To describe the five main types of burn injury.

4. Describe the physiological sequelae for burn injury.

Carotid Stenosis

Module Goal:The purpose of this module is to review cerebral vascular occlusive disease and its relation to symptoms of carotid stenosis, list the damage caused to the brain by a stroke and explain the underlying conditions of a stroke.

Fundamentals:1. To list the damage caused to the brain by a stroke.


Cholecystitis

Module Goal:In this module you will be introduced to the pathophysiology of acute cholecystitis and other diseases related to cholelithiasis and understand the role of anatomy in determining the disease process.

Fundamentals:2. To describe the relevant anatomy of the gall bladder and its impact on the symptoms of inflammation.

3. To explain the underlying conditions of a stroke of a stroke.

Colon Cancer

Module Goal:At the end of this module, you will be able to determine the epidemiology of colorectal cancer in the United States, understand the pathophysiology of colorectal cancer, determine a framework for the treatment and management of colon cancer and recognize ways to detect colon cancer polyps at an early stage.

Fundamentals:1. To determine the epidemiology of colorectal cancer in the United States.

2. To understand the pathophysiology of colorectal cancer.

3. To determine a framework for the treatment and management of colon cancer and recognize ways to detect colon cancer polyps at an early stage.

Diverticulitis

Module Goal:At the end of this module, you will be able to understand clinical presentation of diverticular disease and complications, describe imaging findings suspicious for diverticular disease, explain endoscopic findings for diverticular disease and determine management options for diverticular disease.

Fundamentals:1. To understand clinical presentation of diverticular disease and complications.

2. To describe imaging findings suspicious for diverticular disease.

3. To understand endoscopic findings for diverticular disease.

4. To determine management options for diverticular disease.

Hypercalcemia

Module Goal:At the end of this module you will be able to describe the overall incidence/prevalence of hypercalcemia, define hypercalcemia and explain the pathway for calcium metabolism in the human body.

Fundamentals:1. To describe the overall incidence/prevalence of hypercalcemia.

2. To define hypercalcemia.

3. To explain the pathway for calcium metabolism in the human body.

4. To differentiate between primary, secondary, and tertiary hyperPTH.



Inguinal Hernia

Module Goal:The purpose of this module is to become familiar with the anatomy of the groin, understand the anatomical difference between an indirect and direct hernia and describe the anatomical difference between an inguinal and femoral hernia.

Fundamentals:1. To describe the relevant anatomy of the groin.

2. To understand the anatomical difference between an indirect and direct hernia.

3. To describe the difference between inguinal hernias in adults and children.

Lung Cancer

Module Goal:At the end of this module, you will be able to understand the tremendous burden of disease due to lung cancer world-wide and recognize how the pattern of presentation is linked to extent of disease.

Fundamentals:1. To understand the burden of disease for lung cancer world-wide.

2. To understand the current Staging System and the prognostic significance of each stage.

3. To understand the risk factors for lung cancer including the environmental, behavioral, and occupational factors contributing to risk.

4. To understand the risks and benefits of screening programs for lung cancer.

Pediatric Hernia

Module Goal:At the end of this module you will be able to understand the workup of a patient with a groin mass and describe the embryological descent of the testis, closure of PPV, and formation of inguinal canal.

Fundamentals:1. To recognize the workup of a patient with a groin mass

2. To identify the embryological descent of the testis, closure of PPV, and formation of inguinal canal.

Pediatric Pyloric Stenosis

Module Goal:The purpose of this module is to understand clinical presentation of hypertrophic pyloric stenosis and its complications. Describe imaging findings and exam findings for pyloric stenosis and determine preoperative and postoperative management of pyloric stenosis.

Fundamentals:1. To demonstrate clinical presentation of hypertrophic pyloric stenosis and its complications.

2. To understand imaging findings and exam findings for pyloric stenosis.

3. To determine preoperative and postoperative management of pyloric. stenosis.



Trauma Resuscitation

Module Goal:At the end of this module you will be able to recognize and rapidly assess the severity of a trauma patient and understand the clinical approach to the trauma patient and the ABCDEs of trauma.

Fundamentals:1. To recognize and rapidly assess the severity of a trauma patient.

2. To identify the clinical approach to the trauma patient and the ABCDEs of trauma.



CURRICULAR EXPRESSION

• Attend all orientation sessions.

• Report to the attending on each of the assigned surgical services.

• Receive patient assignment, and OR assignments on each service.

• To participate on night call as per prearranged schedule, attend all trauma codes and consults.

• Log all patient encounters and work hours into One45. H&P’s will be turned in every Monday to coordinator.

• Attend all meetings required by Administration with proper notification to clerkship director.

• Attend all didactic sessions unless you are scrubbed in the operating room or are participating in clinic or offices of faculty Surgeons.

• Be prompt in responding to beeper pages especially on night call and be responsive to follow directions from resident staff.

• Report to clerkship director any breeches of professionalism and/or harassment.


REQUIRED CLINICAL EXPERIENCES

Students are responsible for logging patient encounters into One45 on a weekly basis. Each Monday, the clerkship coordinator will pull patient encounters from One45 for the clerkship director to review. The clerkship director will determine if students are getting adequate exposure to the disciplines of surgery. Students will be graded at midpoint of the rotation and at the end of the rotation on the number of encounters, accuracy and timely submission. The total points for entering patient logs will be 10 points; 5 at mid-term and 5 at the end of the rotation.

Patient Type/Clinical Condition (# required)

Procedures/Skills (# required)

Clinical Setting Level of Student Responsibility

Abdominal (10) -- Inpatient/Outpatient Participate

Breast Disease (5) -- Inpatient/Outpatient Participate

Oncology (5) -- Inpatient/Outpatient Participate

Vascular(5) -- Inpatient/Outpatient Participate

Trauma/Acute Care (10) -- Inpatient/Outpatient Participate

General/Miscellaneous (20) -- Inpatient/Outpatient Participate

Endoscopy (5) -- Inpatient Observe

-- Local Injection (1) Inpatient/Outpatient Perform

-- Foley Catheter placement, Male (1) Inpatient Observe

-- Nasogastric placement (1) Inpatient Perform

-- Suture removal (1) Inpatient/Outpatient Perform

-- Wound closure (1) Inpatient/Outpatient Perform

Perform: Student is personally, actively involved in the procedure or direct care of the patient through history and physical examination, documentation of clinical notes and may include presentation to faculty/residents in either the inpatient or outpatient setting.

Participate: Student is actively involved as a member of the patient care team

Observe: Student is present but not personally, actively involved in the procedure or patient care activity.

LEVELS DEFINED


REQUIRED CLINICAL EXPERIENCES

History & Physical/Direct ObservationStudents are required to turn in five (5) history and physicals (H&P) for the clerkship director to review. If submitted history and physicals are not adequate, the clerkship director will review them with the student. Attendings will observe one (1) H&P and the students will submit a direct observation card provided to them at orientation.

DIRECT OBSERVATION CARD

Student Name: Student Initials:

Required Activity Date Feedback (Y/N) Satisfactory/Unsatisfactory Attending’s Name Initials

Perform an observed interview history on an inpatient or outpatient

Perform observed physical examination on an inpatient or outpatient

Perform written H&P or SOAP note

Descriptors of Competencies Demonstrated During the Observed Activity

Medical Interviewing Skills: Facilitates the patient’s telling of story; effectively use questions/directions to obtain accurate, adequate information needed, responds to affect, non-verbal clues.Physical Examination Skills: Follows efficient, logical sequence; balances screening/diagnostic steps for problem; informs patient; sensitive to patient’s comfort, modesty.

Sample Direct Observation Card


EVALUATION SUMMARY

Grade Components Percentage of Grade

National Board Shelf Exam 30%

Mid-term Shelf Exam 5%

Professionalism 20%

Clinical Evaluations 30%

Online Modules 15%

100%

YOUR TOTAL GRADE IS A SUM OF FIVE COMPONENTS:

National Board Shelf Exam• Minimal passing score 60

• Score <60 is an incomplete until retaken

• Second Score <60 is a clerkship failure

• Maximum points towards grade is 30

• Points from shelf = Shelf Score 30/100

Mid-Term Shelf Test• Maximum points toward grade is 5

• Points from mid-term = score 5/100

Professionalism• 4 components worth 5 points each

- Complete & turn in 5 H&Ps and 1 Direct observation form

- Mid-term patient encounters log up to date at the midweek evaluation

- Final patient encounters log up to date within one week of completion of the clerkship and all minimum requirements met

- Overall professionalism

• A score of <10 points is considered an incomplete and will require remediation

• Points from Professionalism = total of the 4 components

• Maximum points toward grade is 20

Clinical Evaluations• 4 evaluations are to be turned in, one at the end of each 2 week block

• Maximum points toward grade is 30

• Points from the 4 evaluations divided by the total points available after excluding any n/a responses *30/100

Online Modules• Maximum points toward grade is 15

Exam policy requires all students to take the exams at the prescribed time and place. Failure to attend any exam will result in a clerkship failure or an incomplete at the discretion of the clerkship director. The exam must be rescheduled and taken at a time prescribed by the clerkship director, failure to do so will result in a clerkship failure.

Each of the components must be individually passed and a composite score of >59 points will be required to pass the rotation.


Shelf Test <60

Clinical Evaluations <15

Patient Logs, etc. <10

Failure of any individual component requires remediation:

• Meet with the clerkship director

• Shelf Test <60. Retake the Shelf Test.

• Clinical skills <15 will require a specific remediation plan based upon skills evaluation. Options include:

- Timed period 1-3 weeks

- Specific history & physical exams

• Patient logs <10. Improperly recorded & documented despite attempts to correct deficiencies.

• Any remediation component failed a second time will require the clerkship to be repeated.

• Students who are required to remediate any component of a clerkship (with the exception of incomplete clinical encounters-ICE) may not do so during a subsequent clerkship.

• All remediation events must be completed within 8 weeks of the end of Year 3. Students will not be allowed to enter Year 4 until all remediation events are successfully completed.

• Students who fail to complete remediation within 8 weeks will be required to go before the SAPC.

Policy of Repeat ClerkshipRemediation on case-by-Case basis depending on deficiencies may include the following:

• Further time on floor, OR, or clinic and/or attendance on trauma code

• Repeat shelf test

REMEDIATION POLICY


MUSM POLICIES

Students on the clerkship are expected to maintain the highest standards of professionalism, and to abide by all MUSM policies, including the MU Honor Code, the Medical Student Code of Honor and Professional Conduct, Dress Code, Duty Hour Requirements, bloodborne pathogen response program, and attendance as recorded in the MD Program Handbook.

Participation is expected at all scheduled activities unless otherwise directed by the clerkship director. Students are expected to remain on the hospital property during ‘on-call/night float’ periods, unless directed otherwise by their attending physician or clerkship director.


COLUMBUS CAMPUSSt. Francis Hospital Mercer University School of Medicine 2122 Manchester Expressway Dean’s Office Columbus, GA 31904 33 West 11th Street 706-596-4000 P.O. Box 870 Columbus, GA 31902-0870

Clerkship Director: Jim Majors, MD Clerkship Coordinator: Janelle Hollis Office Phone: 706-324-3243 Office Phone: 706-223-5181 Email: [email protected] Email: [email protected]

MACON CAMPUSMedical Center, Navicent Health Mercer University School of Medicine Med Ed, Surgery and Trauma Services Dean’s Office 777 Hemlock Street, MSC 140 1550 Mercer University Drive Macon, GA 31201 Macon, GA 31207 478-633-1000

Clerkship Director: Danny Vaughn, MD Clerkship Coordinator: Vickie Harris Office Phone: 478633-1891 Office Phone: 478-301-5810 Fax: 478-633-5153 Fax: 478-301-5841 Email: [email protected] Email: [email protected]

SAVANNAH CAMPUSMemorial Health University Medical Center Mercer University School of Medicine 4700 Waters Ave. Dean’s Office Savannah, GA 31404 1250 E. 66th Street 912-350-8000 Savannah, GA 31404

Clerkship Director: Miller Hamrick, MD Clerkship Coordinator: Maureen Parrish Office Phone: (912) 350-7914 Office Phone: 912- 712-8211 Fax: 912-350-7973 Fax: 912-721-8267 Email: [email protected] Email: [email protected]

APPENDIX A:CAMPUS CONTACTS

mailto:majorsj%40sfhga.com?subject=

mailto:hollis_j%40mercer.edu?subject=

mailto:vaughn.danny%40navicenthealth.org?subject=

mailto:harris_vl%40mercer.edu?subject=

mailto:[email protected]

mailto:parrish_m%40mercer.edu?subject=


APPENDIX B:SUGGESTED READING

Blackbourne, L.H. Surgical Recall 8th Ed. 2017

Brunicardi F.C. Schwartz’s Principles of Surgery 11th Ed. 2019

Lawrence, P.F. Essentials of General Surgery 6th Ed. 2018

Silen, W. Cope’s Early Diagnosis of the Acute Abdomen. 22nd Ed. 2010

Townsend, C.C. Jr. et al. Sabiston Textbook of Surgery 20th Ed. 2016

Wapnick, S., et al. Lange Q&A Surgery. 5th Ed. 2007

Jarrell, B. NMS Surgery Casebook, 2nd Ed. 2014


List of Didactic Sessions• ABCs of Trauma

• Anesthesia

• Bedside Procedures

• Blunt Abdominal Trauma

• Burns

• Cardiac Surgery

• Coagulation and Anticoagulation

• Colorectal Disease

• Common Post-Op Complications

• ENT Surgery

• Fluids and Electrolytes

• GI Bleeding

• Hernias

• Liver and Gallbladder

• Medical Ethics

• Medical Legal Issues

• Neurosurgery

• Orthopedic Surgery

• Pancreas

• Pediatric Surgery

• Shock

• Small Bowel

• Stomach and Duodenum

• Surgical Infections and Antibiotics

• Surgical Nutrition

• Surgical Oncology Melanoma

• Suture Class

• Thoracic Surgery

• Thyroid and Parathyroid Disease

• Urology

• Vascular Surgery

• Wound Healing

APPENDIX C:LEARNING RESOURCES


APPENDIX D:CLERKSHIP EVALUATION

Medical students rotating through the surgical clerkship are evaluated by a variety of instruments. The “Surgical” shelf test; the passing score is 60. At the end of the rotation, each student will be assessed by each attending they have worked with based on their clinical skills, knowledge, clinical reasoning and professionalism. The students are also required to turn in five completed histories and physicals which are reviewed by the clerkship director and comments made when necessary. The students will log their patient encounters into One45. These logs will be pulled every Monday for the clerkship director to review.

The students are also evaluated on rounds with the attending surgeons. When indicated comments about student performance are made to the clerkship director and may be passed on to the students when necessary.

The final evaluation is written by the clerkship director, based upon the evaluation tools. Each student receives a copy of the final evaluation. Each student has an opportunity to discuss the evaluation, if there is any disagreement with the comments. Copies of the final evaluations are kept in the students file.

Evaluation Tools• Lecture, interactive discussion

• Patient encounters recorded

• Rounds on patients with resident and attending staff/direct observation

• Faculty/Clinical evaluations

• Shelf test NBME subject test

• Online modules

• Compilation evaluation by clerkship director

- Not every tool is used for every objective

- Grading grid is used to compile score

Evaluation Methods for the Cognitive ObjectivesS = Summative F = Formative

ABC’s of Trauma

Interactive lecture discussions F

Participation in trauma codes F

Rounds on trauma patients F

Recording patient encounters F

Standardized patient evaluations F

Shelf Test S

Faculty Evaluations S

Acute Abdomen

Patient encounters recorded F


Lectures with interactive discussion F

Shelf Test S



Electrolyte Imbalance

Case presentation-interactive discussions with lecture F

Patient encounter evaluation F

Patient management plan with standardized patients F

Shelf Test S


Shock and its Mechanisms

Interactive lecture discussion F

Observation of standardized patient F

Patient encounters in trauma bay F

Evaluation of H&P encounters F

Shelf Test S


Physiologic Monitoring

Interactive discussion with lecture F

Patient encounter recording F

Observation of standardized patient F

Faculty evaluations S

Trauma Bay and ICU

Tour with resident staff F

Patient encounters F

Observation of bedside procedures F

Patient encounter evaluations F

Shelf Test S


Common Surgical Complications



Standardized patient observations F

Shelf test S




Common Surgical Hernias



Shelf test S


Disorders of the Small Intestine and Appendix



Standardized patient observation F

Shelf test S


Blunt Penetrating Trauma of the Abdomen and Chest



Standardized patient observations F

Shelf Test S

Faculty Evaluation S

Malignant Melanoma



Recording of patient encounters F

Shelf Test S

The Recognition and Management of Common Traumatic Fractures with the Basic Principles of Management



Patient encounter F

Shelf Test S




The Evaluation of Burns, Diagnosis and Management Plans



Shelf Test S

Faculty Evaluation S

Discuss the Diagnosis and Principle of Management of Surgical Conditions of the Liver, Gall Bladder and Biliary Tree


Standardized patient encounters F


Shelf test S


Define and Diagnose Common Surgical Conditions of Thoracic and Abdominal Cavity to include Trauma, COPD, Infections and Tumors



Shelf Test S


Define, Diagnose and Manage the Surgical Diseases of the Breast to include Benign and Malignant Tumors and Infections



Interaction and evaluation F

Shelf Test S


The Student should be able to make logical choice for the use of antibiotics in surgical infections



Standardized patient evaluation F

Shelf test S




Student should be able to discuss, diagnose and preliminary manage surgical conditions of the thyroid and parathyroid


Shelf test S


The Student should be able to review, discuss and diagnose common ENT conditions to include tumors and infections but with emphasis on masses of unknown diagnosis in the neck.


Shelf test S


Student should be able to review the principles in the Management of the GI Tract bleeding from the upper to the lower GI Tract.



Shelf test S

Faculty evaluation S

Student should understand basic concepts of the Neurologic exam as it relates to the diagnosis and management as it relates to Subdural, Epidural, and Subarachnoid Bleed. Evaluation of blunt head injury, interpret Glascow coma scare and Neurologic exam for tumors.




The Student should understand and utilize the knowledge in patient care for the basic use of the principles of surgical nutrition.



Shelf test S




The Student will understand, comment on, describe and have a plan of management of the common Pediatric Surgical diagnosis.



Shelf test S


The Student will be able to present Colorectal Disease Principles of management and diagnosis of common colorectal disease found in the surgical patient.



Shelf test S


Genitourinary Surgical Disease Recognition


Wound care and Wound healing, The Student should know how to suture and care for a wound and understand the process of wound healing.

Suture demonstration with class F

Shelf test S






COLUMBUS CAMPUS

• There are five call days required during the rotation. Record them in the call log in Dr. Major’s office. There is no call the last week of the rotation.

MACON CAMPUS

• Night Float and Weekend Call: There will be six (6) weeks of night float starting and ending on the first and last Sunday of the rotation. Night float will start Sunday at 7:00 PM and end Friday at 7:00 AM each week (7:00 PM - 7:00 AM daily). Students are required to attend M&M and Grand Rounds but must vacate the hospital IMMEDIATELY afterward.

• The first day of call will be Friday night during the first week of the rotation. Students will be on call Friday night at 7:00 PM until Saturday at 7:00 AM. Saturday at 7:00 AM - Sunday at 7:00 AM will be another call day. There will be a 12-hour call shift on Sunday from 7:00 AM - 7:00 PM until the night float person comes in. Students must vacate the hospital IMMEDIATELY after their call shift. The last call shift will end at 7:00 PM on Sunday of the last week of the rotation.

• Once the call and/or night float schedule is fixed, any changes must be given to the clerkship coordinator. The coordinator must have the capability to see where you are at any given time in case someone else may need you.

SAVANNAH CAMPUS

• Night Float and Weekend Call: There will be one Saturday call during the rotation. Call will be from Saturday at 6:00 AM – Sunday at 6:00 AM. A standard night float week starts on Sunday at 6:00 AM - Friday at 6:00 AM. On Thursdays, night float begins at 7:00 PM.

APPENDIX E:WORK RULES

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