GOALS FOR THE CLERKSHIP GOALS - The goal of the Fourth Year Surgical Subinternship is to prepare the student to enable learners to acquire the essential cognitive, technical, and communication skills needed to be well prepared for the first year of residency regardless of the specialty. Specifically, the overarching goals are: To emphasize the clinical application of medical knowledge within the context of actual patient care To increase the clinical autonomy of the subinterns and to increase their sense of patient ownership To ensure that students are assigned clinical loads that are similar to those expected of the intern on the service Page 1 of 7
CLERKSHIP OBJECTIVES PHYSICIANSHIP OBJECTIVES - Complementary to specific knowledge and skills objectives, students are expected to demonstrate ongoing growth in the area of interpersonal and communication skills, medical ethics and moral reasoning, practice-based learning and improvement and professionalism. During the clerkship, the student will: Develop and discuss appropriate patient care plans with attending surgeons on actual and simulated cases. (PCMC-3) Work up and manage common postoperative complications (postoperative shortness of breath, hypotension, chest pain, fever, wound complications, low urine output and acute mental status changes) during patient care duties as well as through assigned online modules. (PCMC-3) Develop and describe appropriate management plans for patient complaints when responding to mock pages reflective of typical clinical challenges faced by first year surgery residents. (PCMC-3) Demonstrate ability to properly counsel patients and obtain proper surgical consent under the supervision of a chief resident or attending surgeon. (PCMC-6) Competently present and discuss with the clerkship director a clinical case scenario reflective of adaptive thinking. (MKS-3a, MKS-3b) Demonstrate professional communication skills utilizing SBAR methodology when communicating with healthcare professionals, when responding to mock pages and during simulation exercises. (ECIS-3, SATBC-3) Demonstrate skills in appropriately handing off care of patients during patient care duties as well through assigned online modules. (SATBC-3) Behave with honesty, integrity, respect and compassion towards all patients, families, allied health professionals and colleagues. (PBMR-3) Ask for and give appropriate and timely feedback to team members in a non-confrontational or non-defensive manner. And demonstrate ability to create a well-articulated plan for improvement. (CLQI 1a, CLQI-2) Page 2 of 7
HISTORY AND PHYSICAL EXAM OBJECTIVES HISTORY and PHYSICAL OBJECTIVES - During the 4 week subinternship students will perform a focused history and physical exam on numerous real patients for a variety of presenting complaints. At the completion of the clerkship each student will be able to obtain a focused history and perform a focused physical exam for each complaint in a timely manner as assessed by direct observation. Physical Exams Specific Physical Examination Objectives Perform and present concise history and physical examination (EPA 1/EPA 6) (PCMC-1, PCMC-2) Resources Bates Online resources Where in the Clerkship it is Taught Office hours in assigned clinic How Assessed Direct Observation Feedback Opportunities Clinical Opportunities During office hours and on direct observation forms Office hours in assigned clinic Page 3 of 7
SKILLS OBJECTIVES SKILLS OBJECTIVES - During the 4 week clerkship students will perform the following skills on the specified number of real or simulated patients. At the completion of the clerkship each student will be able to perform these skills in a controlled setting with supervision as assessed by the nurse educator and clerkship director in the end of rotation skills testing session. SKILL Specific Knowledge Objectives Resources Where in the Clerkship it is How Assessed Knot tying Surgeon s knot (PCMC-4) Single-handed knot (PCMC-4) Two-handed knot (PCMC-4) Text/Electronic Adjuncts NEJM Videos Taught Skills Session in simlab Verification of proficiency evaluation Suturing Chest tube placement Central line placement FAST Exam Simple interrupted suture (PCMC-4) Subcuticular suture (PCMC-4) Vertical mattress suture (PCMC-4) Placement of a chest tube on a mannequin in the skills lab (PCMC- 4) Placement of a central venous catheter in a mannequin in the skills lab (PCMC-4) Perform the FAST exam and capture the appropriate four views for the exam (PCMC-4) Page 4 of 7
KNOWLEDGE OBJECTIVES KNOWLEDGE OBJECTIVES - At the completion of the 4 week surgery subinternship, the student should have studied the following material at least ONCE via clinical encounter, didactic sessions, simulation OR through self study. Page 5 of 7
General Knowledge Objectives TOPIC Specific Knowledge Objectives Resources Where in the Clerkship it is Taught Identify and manage unstable and critically ill patient (equivalent to EPA 10) (PCMC- 3, MKS-3b) Text/Electronic Adjuncts Independent readings, didactics, web modules, simulation How Assessed Mock pages, small group sessions Manage common perioperative patient problems (PCMC-3, MKS-3b) Demonstrate understanding of the pharmacology of common medicines: analgesia, nausea/vomiting medicines, antibiotic groups (MKS-1e) Demonstrate understanding of the risks and benefits for common surgical procedures (PCMC-4) Demonstrate understanding of the relevant anatomy for common surgical procedures (MKS-1a, PCMC-4) Didactics Small Group/Sim Sessions Professor rounds Page 6 of 7
Demonstrate understanding of the indications for specific surgical procedures (PCMC-4) Demonstrate the understanding of common surgical equipment and materials (e.g., electrosurgical unit, types of mesh and suture materials) (MKS-1e) Page 7 of 7