Curriculum

Surgery Clerkship

Director: Yee Men Wong, MD, Clerkship Director, and Assistant Professor, Surgery

Clerkship Description: The Surgery clerkship goal is to ensure students acquire the skills and knowledge that all physicians need to know in order to manage patients with conditions commonly treated by surgeons.

Boonshoft SOM Educational Objectives/Competencies

Code

What competencies will this unit address?  

Foundational Knowledge – Medical Knowledge

1.1

Master fundamental biomedical concepts, terms, processes, and system interactions

Foundational Knowledge – Medical Knowledge

1.2

Describe the determinants of health

Foundational Knowledge – Medical Knowledge

1.3

Utilize evidence in making clinical decisions

Application – Patient Care (Clinical Skills)

2.1

Conduct patient interviews and physical examinations

Application – Patient Care (Clinical Skills)

2.2

Diagnose patient health problems

Application – Patient Care (Clinical Skills)

2.3

Propose evidence-based health maintenance and therapeutic treatments

Integration – System-Based Practice

3.1

Connect knowledge of patient populations and health delivery processes in making diagnoses and therapeutic recommendations

Integration – System-Based Practice

3.2

Advocate for the humane, just, safe and prudent care of persons

Integration – System-Based Practice

3.3

Adapt to the complex economic and social structure of health care delivery

Human Dimension – Personal and Interpersonal Professional Development Goals

4.1

Reflect upon one’s personal strengths and weaknesses to make changes in one’s behavior

Human Dimension – Personal and Interpersonal Professional Development Goals

4.2

Find one’s own meaning in medicine 

Human Dimension – Personal and Interpersonal Professional Development Goals

4.3

Take care of oneself

Human Dimension – Personal and Interpersonal Professional Development Goals

4.4

Deliver effective patient presentations and document accurately in the medical record

Human Dimension – Personal and Interpersonal Professional Development Goals

4.5

Communicate and work effectively with others

Human Dimension – Personal and Interpersonal Professional Development Goals

4.6

Demonstrate leadership skills in a variety of settings

Caring/Valuing – Professionalism Goals

5.3

Value and behave in a manner consistent with the highest ethical standards of the profession

Learning How to Learn – Practice-Based Learning

6.1

Develop a personal plan to become a better medical professional

Learning How to Learn – Practice-Based Learning

6.3

Appropriately utilize evidence-based resources to address uncertainty in medicine and gaps in knowledge/skills

Clerkship-Level Objectives

Code

What are the clerkship-level objectives for this course?  

Boonshoft SOM Objectives

LO1

Frame a patient encounter in an organized fashion, reinforcing etiology, pathophysiology, clinical manifestations, diagnostic strategies and therapeutic interventions.

1.1, 2.1

LO2

Explain disease specific treatment strategies and associated prognosis and complications.

1.1, 2.1

LO3

Evaluate patients’ presenting clinical problems, including: abdominal pain, breast mass, colorectal disease, biliary tract disease, ventral/inguinal hernia, skin and soft tissue lesions, and traumatic injury.

1.1, 2.1

LO4

Diagnose and manage surgical conditions in patients with acute and chronic conditions including: substance abuse, altered mental status, malignancy, DM, hypertension, and obesity.  Participate in surgical procedures including, but not limited to: appendectomy, breast surgery, colon/small bowel surgery, cholecystectomy, hernia repair, tracheostomy, PEG tube placement, surgery of skin and/or soft tissue, and technical skills (Foley catheter placement, suturing and know typing, wound care). 

1.1, 2.1, 2.2, 2.3

LO5

Apply the fundamentals of surgical care to coordinate the care of acutely and chronically ill adults as well as traumatically injured patients.

1.1

LO6

Demonstrate systematic approach to adult patients utilizing sound skills in gathering components of the history and physical exam.

2.1, 4.4

LO7

Demonstrate appropriate interpretation of labs and testing.

2.2

LO8

Begin to formulate diagnostic reasoning, and justify therapeutic decision-making.

1.3, 2.2, 2.3

LO9

Demonstrate clear and concise oral presentations and written documentation reflecting a systematic approach to adult patients.

2.1, 4.4

LO10

Identify the social determinants of health for a specific patient, and develop a plan to coordinate care to include community resources to try to improve the health of the individual.

1.2, 3.1, 3.2

LO11

Consider patient, physician, and system barriers to successfully negotiate treatment plans and patient adherence; and identify strategies that may be used to overcome these barriers.

1.2, 3.1, 3.2

LO12

Identify the role of each team member to the care of the patient, and call on interdisciplinary resources to provide optimal and comprehensive care.

3.3, 4.5, 4.6

LO13

Establish professional relationships and effectively communicate with patients, their families, instructors, colleagues and staff.

4.1, 4.3, 4.5, 4.6

LO14

Work effectively with the broad, interdisciplinary team in patient care and appropriately incorporate their unique care skills.

4.1, 4.3, 4.5, 4.6

LO15

Demonstrate the ability to act with honesty/integrity while maintaining ethical duties to patients and others.

5.3

LO16

Demonstrate the ability to act in a manner that is dependable, dedicated and punctual.

5.3

LO17

Demonstrate the ability to act with patience, altruism and equanimity.

5.1, 4.1, 4.6

LO18

Recognize when additional information is needed to care for the patient and demonstrate ongoing commitment to self-directed learning.

6.3

LO19

Demonstrate effective skills in navigating the medical literature to answer clinical care questions.

6.3

LO20

Demonstrate the ability to acquire and soundly manage knowledge, identify knowledge deficiencies and create a plan for knowledge gains

4.2, 6.3

LO21

Demonstrate the ability to seek out and listen to feedback on performance, accept it positively, and respond to it constructively by improving performance.

4.5, 4.3, 4.1

Required Clinical Experiences

During your Surgery Clerkship, you will be involved in the preoperative, operative, and postoperative care of patients – all very important aspects in the delivery of care!  It is required that you log all of your patients and cases in the logger in BAMS. You will need to select your “level of participation” when you log your cases: observation, moderate participation, or full participation. To ensure a breadth of exposure during your clerkship, it is expected that you will need the minimum defined cases with the level of responsibility indicated.

Encounter Log Items

Target

Expected Level of Responsibility

Examples (if applicable) Including but not limited to:

Cancer

1

Moderate participation  

Diabetes

1

Moderate participation Participation in the management of a patient with DM as a complicating comorbid condition and/or sequelae

Hypertension

1

Moderate participation Participation in the management of a patient with HTN as a complicating comorbid condition and/or sequelae

Obesity

1

Moderate participation Participation in the management of a patient with obesity as a complicating comorbid condition and/or sequelae

Abdominal pain – evaluation and workup

1

Moderate participation  

Breast mass – evaluation and workup.  Benign or malignant.

1

Moderate participation Breast cyst, fibroadenoma, breast cancer

Colorectal disease – evaluation and workup.  Benign or malignant.

1

Moderate participation Appendicitis, bowel obstruction, GI bleeding, inflammatory bowel disease, diverticular disease, ischemic colitis, gastrointestinal malignancies

Biliary tract disease – evaluation and workup

1

Moderate participation Acute and chronic cholecystitis, jaundice

Hernia (ventral, incisional, or inguinal) – evaluation and workup.

1

Moderate participation Ventral, umbilical, incisional, inguinal hernias – with and without acute incarceration and/or strangulation

Skin and soft tissue –evaluation and workup.  Benign or malignant.

1

Moderate participation Skin lesions (benign and malignant), soft tissue masses (benign and malignant), abscesses

Procedure Log Items

Target

Expected Level of Responsibility

Examples (if applicable) Including but not limited to:

Minimally invasive surgery

1

Assisted in the procedure

Any laparoscopic or robotic surgery

Open surgery

1

Assisted in the procedure

Exploratory laparotomy, open vascular surgery, thoracotomy

Breast/skin/soft tissue surgery

1

Assisted in the procedure

Breast mass excision, drainage of breast abscess, mastectomy, lipoma or cyst excision, excision of skin lesion/skin cancer, drainage of abscess, debridement of skin and soft tissue

Small bowel surgery

1

Assisted in the procedure

Small bowel resection, lysis of adhesions, repair of enterotomy

Colorectal surgery

1

Assisted in the procedure

Colon resection, appendectomy, ostomy creation, low anterior resection, hemorrhoidectomy, drainage of peri-rectal abscess

Hepatobiliary surgery

1

Assisted in the procedure

Cholecystectomy, liver resection, Whipple procedure, hepatorrhaphy

Hernia repair

1

Assisted in the procedure

Ventral, incisional, umbilical, inguinal, femoral hernia repair, with or without mesh

Technical skills: suture

2

Fully performed procedure

Repair of lacerations, closure of port sites or incisions, simple interrupted, simple running, subcuticular, or mattress stitch

Technical skills: knot tying

2

Fully performed procedure

Instrument tie, two-handed or one-handed tie

Other surgery ***

10

Assisted in the procedure

 

Observation: Student is observing encounter

Moderate Participation: Student completes the History and Physical (either complete or focused) and participates in the differential diagnosis. (*Student directly interacts with the patient)

Full Participation: Student completes History and Physical (either complete or focused), participates in the differential diagnosis, and then completes a therapeutic treatment plan, which can include documentation.

For procedures:

            Observation

            Assisted in the procedure

            Fully performed the procedure

 

Last edited on 04/20/2021.