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M3 Surgery 900 Junior Surgery Clerkship

Surgical problems and diseases are studied utilizing didactics, skills laboratory experiences, simulations, assigned readings, clinical rotations and operating room participation. This course prepares the student to meet competencies and objectives of the KU School of Medicine during the third year of medical school.

The skills taught in this course are in the hospital setting and through simulation. The student is expected to have successfully completed Phase I of medical school, which includes the ability to demonstrate competent understanding of normal and abnormal body structure and function, ability to competently perform and document a History and Physical Examination, and the ability to competently record diagnoses and procedures.

Students are assigned two 4-week rotations.

Welcome

The faculty and staff of the Surgery Department are dedicated to providing our medical students with a rewarding educational experience while on the Surgery rotation.

Delcore Romano

Romano Delcore, MD, MBA, FACS
Professor and Chair, Department of Surgery



berbel german

German Berbel, DO, FACOS
Associate Professor of Surgery
Clerkship Director, Surgery, Kansas City Campus

soulikias james

James Soulikias
Senior Coordinator for Surgery Education
Department of Surgery

Clerkship Overview

Welcome to the Surgery Clerkship for Phase II medical students at the KU School of Medicine. Here are some of the important things to bear in mind during your clerkship in surgery and the rest of medical school. It is our goal to help you reach the goals of the Graduation Competencies of the KU School of Medicine.

1. Professional attire and demeanor are required during the rotation

The goal of medical school is to teach the art and science of medicine. It is important that you now begin to envision yourself as a practicing physician (not just a 3rd-year medical student) and adopt the habits of a medical professional. See Student Professional Attire Policy/OR Guidelines

  • You should ask yourself what you would do in the clinical situations you are exposed to as if you were the physician actually making the decision.
  • Dress in appropriate street clothes each day.
  • Remember that scrub clothes are appropriate attire for the operating room and for times spent on-call.
  • Retain respect for patients, peers, and co-workers despite long hours, stressful situations and great demands put upon you.
2. Student duties for patient care

Chief Residents typically make inpatient and OR patient assignments. You are expected to see your patients and be prepared for rounds and the OR. Typical student inpatient responsibilities would be 3-5 patients. Larger patient loads are discouraged so as to maximize the learning from each patient. See Medical Student Model 80 Hour Week and KU School of Medicine Student Work Duty Hours Policy.

A student on-call scheme is determined by each service and should be available to the residents. General Surgery Call at KU Medical Center is voluntary. Students are granted the "Golden Weekend" at the conclusion of the fourth week of the block and constitute the freedom from clinical duties outlined in the KU School of Medicine Student Work Duty Hours Policy.

3. Rounds and OR preparation

Each patient that a student accompanies to the OR should be approached in a manner that maximizes the learning experience for the student. You should find out the OR schedule and your assignment several days in advance so that you can properly prepare.

Patients whom the student encounters as an inpatient should receive a complete History and Physical Exam with Assessment and Plan by that student. Patients whom the student first encounters on the day of surgery would be ideally examined for the pertinent findings relative to that day’s operation during the pre-operative “holding” or pre-anesthetic phase. (It is recognized that this is not always possible, but should be a goal so that pre-operative findings can be correlated with operative findings and pathological findings).

Regarding rounds on inpatients, usually the student is expected to deliver an oral presentation of the complete H&P during the first 24 hours of hospitalization and give updates of developments during each subsequent set of rounds. The H&P is presented orally but in varying degrees of detail depending on time, service, resident, attending and patient problem.

The H&P is frequently required as an oral presentation during the beginning of operations. The student should be prepared to present the entire or the focused version depending on circumstances as indicated above. The presentation remains in the same order whether focused or not following the format you learned in Bates Guide to Physical Examinations and History Taking. The Assessment portion of the H&P lists the problems identified in the H&P and develops a working diagnosis for each of the major/active problems.

The Plan portion of the H&P will usually include the name of the operation proposed.

4. Didactic Sessions and Skills Labs

Attendance at all Skills Labs, Orientation, Mid-Clerkship Feedback Session, Oral Case Presentation and Exam, and the NBME "Shelf" Exam is required. Students are freed from clinical duties during mandatory events, didactic sessions & skills labs. Various teaching techniques are used including didactic lecture, combined didactic/Q&A, or purely Q/A, simulation and skills demonstrations.

Attendance at didactic sessions and grand rounds is strongly encouraged but attendance is not recorded. More than 90% of the didactics are recorded in Podcast format.

In clinical medicine, it is appropriate to express appreciation for the instructor's effort by clapping at the end of the session.

Four study days during each block are scheduled. The schedule is accessible in JayDocs. Students are freed from clinical duties on those days.

5. Reading and preparation

Lawrence and NMS are the basic recommended texts to read and to prepare for didactic sessions. See above link for Didactic Recommended Reading Assignments.

In addition to reading in preparation for didactic sessions, it is essential that the student read about the disease processes affecting his/her patients. A good way to assimilate the fund of knowledge necessary to be a successful physician is to observe a finding or disease entity in a patient and then read about it in a textbook or journal.

Successful students:

  • Read from a major textbook by authors such as Schwartz, Sabison, Cameron or Greenfield in addition to the Lawrence texts.
  • Consult Surgical Atlases to prepare for OR cases
  • Read and understands textbook information BEFORE consulting recent journal literature.
  • Read about didactic topics BEFORE the session
  • Review/verify understanding of topics by using “Quiz”/Review books/resources
  • Prioritize mastery of the identified topics of the curriculum

Each time a student reads about a clinical disease entity, he/she should attempt to assimilate information in the following categories: incidence, etiology, pathophysiology, symptoms, signs, differential diagnosis, diagnostic testing, natural history of the disease, treatment (medical, surgical, etc.) including techniques and dosages, prognosis based on treatment or non-treatment, and incidence and type of complications as a result of treatments.

The following links take you to the curriculum of the course:

Interested students may create a free account at GIBLIB to access a wide selection of surgical videos and medical lectures. Visit giblib.com to get started.

6. Test preparation

Reading from the Lawrence textbook is the place to start and should be done before the didactic session is presented. The next step is to review your didactic session notes, PowerPoints, Podcasts and handouts. Review your understanding and recall with NMS or other outline/Q&A books after the basic reading and notes review has been performed. Outlining and note taking from readings and didactics is highly recommended.

7. Recording Patient Encounters

The KU School of Medicine requires students to log patient encounters.

Summary

Every student is welcomed to the clerkship and we hope that each student has a valuable learning experience.

James Soulikias, the clerkship coordinator, is located in the Department of Surgery, 4000 Murphy. He can be reached at 913.588.7323 and handles the day-to-day workings of the course.

The Clerkship Director, Dr. Berbel, is available by appointment through the Surgery Education Coordinator to discuss matters related to grades, residency, recommendation letters, course content, working/learning conditions, and other matters pertinent to the course.

Student Professional Attire Policy/OR Guidelines

In addition to  KUMC Student Dress Code standards Surgery Education has adopted the ACS Guidelines for appropriate Attire for Student Health Care Professionals.

Statement on Operating Room Attire
The Board of Regents of the American College of Surgeons (ACS) approved this statement in July 2016.  https://t.co/yk9UDfbPey

The tenets of the American College of Surgeons (ACS) include professionalism, excellence, inclusion, innovation, and introspection. Appropriate attire is a reflection of professionalism and facilitates establishing and maintaining a patient-physician rapport based on trust and respect. In addition, in so far as clean and properly worn attire may decrease the incidence of health care-associated infections, it also speaks to a desire and drive for excellence in clinical outcomes and a commitment to patient safety.

The ACS guidelines for appropriate attire are based on professionalism, common sense, decorum, and the available evidence. They are as follows:

  • Soiled scrubs and/or hats should be changed as soon as feasible and certainly prior to speaking with family members after a surgical procedure.
  • Scrubs and hats worn during dirty or contaminated cases should be changed prior to subsequent cases even if not visibly soiled.
  • Masks should not be worn dangling at any time.
  • Operating room (OR) scrubs should not be worn in the hospital facility outside of the OR area without a clean lab coat or appropriate cover up over them.
  • OR scrubs should not be worn at any time outside of the hospital perimeter.
  • OR scrubs should be changed at least daily.
  • During invasive procedures, the mouth, nose, and hair (skull and face) should be covered to avoid potential wound contamination. Large sideburns and ponytails should be covered or contained. There is no evidence that leaving ears, a limited amount of hair on the nape of the neck or a modest sideburn uncovered contributes to wound infections.
  • Earrings and jewelry worn on the head or neck where they might fall into or contaminate the sterile field should all be removed or appropriately covered during procedures
  • The ACS encourages clean appropriate professional attire (not scrubs) to be worn during all patient encounters outside of the OR.

The skullcap is symbolic of the surgical profession. The skullcap can be worn when close to the totality of hair is covered by it and only a limited amount of hair on the nape of the neck or a modest sideburn remains uncovered. Like OR scrubs, cloth skull caps should be cleaned and changed daily. Paper skull caps should be disposed of daily and following every dirty or contaminated case. Religious beliefs regarding headwear should be respected without compromising patient safety.

Many different health care providers (surgeons, anesthesiologists, CRNAs, laboratory technicians, aids, and so on) wear scrubs in the OR setting. The ACS strongly suggests that scrubs should not be worn outside the perimeter of the hospital by any health care provider. To facilitate enforcement of this guideline for OR personnel, the ACS suggests the adoption of distinctive, colored scrub suits for the operating room personnel.

The ACS emphasizes patient quality and safety and prides itself on leading in an ever-changing and increasingly complex health care environment. As stewards of our profession, we must retain emphasis on key principles of our culture, including proper attire, since attention to such detail will help uphold the public perception of surgeons as highly trustworthy, attentive, professional, and compassionate.

Clerkship Objectives

Patient Care

Students will acquire History and Physical Exam skills which lead to accurate assessment and planning of Surgical Care. [SoM Graduation Competencies-Educational Program Objectives: PC1, PC2, PC3, PC4, PC5, PC6]

Students will demonstrate competent skill in basic surgical techniques and know the proper application of those skills. See the SoM Competencies for Graduation Appendix B, Surgery 900 Target Procedures Tracking Log and Surgery 900 Skills Verification Form. [SoM Graduation Competencies-Educational Program Objectives: PC6]

Medical Knowledge

Students will acquire knowledge of common disease processes in which standard treatment includes surgical considerations. See the SoM Competencies for Graduation Appendix A, Surgery 900 Core Curriculum Learning Objectives and the Surgery 900 Target DiagnosisTracking Log. [SoM Graduation Competencies-Educational Program Objectives: MK1, MK2, MK3]

Practice-Based Learning/Improvement

Students will develop knowledge, skills, attitudes and behaviors toward learning, which perpetuate lifelong learning, inquisitiveness and evidenced-based practice. [SoM Graduation Competencies-Educational Program Objectives: PBL1, PBL2, PBL3, PBL4 ]

Interpersonal and Communication Skills

Students will communicate and collaborate with peers, mentors and allied health care personnel in an effective and professional manner. [SoM Graduation Competencies-Educational Program Objectives: ICS1, ICS2, ICS3, ICS4]

Professionalism

Students will demonstrate professional appearance, attendance and behavior consistent with that expected of a physician-in-training. [SoM Graduation Competencies-Educational Program Objectives: P1, P2, P3, P4 ]

System-Based Practice

Students will understand the roles of medical students on the Surgery Clerkship and the role of Surgeons in health care delivery. [SoM Graduation Competencies-Educational Program Objectives: SBP1, SBP2, SBP3, SBP4, SBP5]

Mandatory Events, Policies, and Procedures

Orientation

Orientation occurs on the first day of the clerkship. Numerous materials are discussed and located on the course information screen of JayDocs.

Mid-Clerkship Feedback Session Policy

The Surgery 900 Mid-Clerkship Feedback Session is held on the 4th Friday of the clerkship (unless changed by the Office of Surgery Education). The session is designed to give feedback to students regarding their progress at that point in the clerkship and to help students to direct themselves toward the objectives and competencies of the clerkship.

The session is mandatory and failure to participate results in an "Incomplete" grade and the consequences outlined in the clerkship grading document.

Complete instructions can be found by clicking the above link "Mid-Clerkship Feedback Session Policy"

Oral Case Presentation and Exam Policy

Near the end of the 8-week Surgery 900 Clerkship, students will present to a small group of faculty and their student peers. This activity is intended to allow students to improve their oral communication skills, demonstrate their ability to research a surgical topic and develop evidence-based treatment, knowledge, and skills.

The session is mandatory and failure to participate results in an "Incomplete" grade and the consequences outlined in the clerkship grading document.

Complete instructions can be found by clicking the above link "Oral Case Presentation and Exam Policy"

End of Clerkship Checklist to Complete and Turn into Surgery Education Office

Complete instructions can be found by clicking the above link "End of Clerkship Checklist to Complete & Turn in to Surgery Education Office"

NBME Surgery Subject Exam Policy

Students are required to take their NBME Surgery Subject Examination ("Shelf" Exam) on the last Friday of the clerkship as scheduled (unless changed by the Office of Medical Education). Students may not request to postpone their shelf exam unless they receive an excused absence from the Dean of Student Affairs. Extenuating circumstances (such as a death in the family or medical emergency) must be communicated to the Dean, the Clerkship Director and Clerkship Administrator immediately if an exam cannot be taken on the scheduled date.

The session is mandatory and failure to participate results in an "Incomplete" grade and the consequences outlined in the clerkship grading document.

Complete instructions can be found by clicking the above link "NBME Shelf Exam Policy"

Rural Rotation

Rural Rotation Policies and Procedures

  • One 4-week block of the 8-week Surgery 900 rotation may be spent at an approved rural site. The student must be approved for the rural rotation. The " Request to Take a Required Third Year Clerkship at a Non-KUMC Location" form must be completed in its entirety for each request and submitted to the Clerkship Administrator.
  • The "Request to Take a Required Third Year Clerkship at a Non-KUMC Location" form is accepted early- mid-April for the entire Academic Year. After the first day of classes (assuming open positions are available) Rural Rotation will be assigned on a first-come, first-served basis. Students applying after the deadline must submit forms to the Clerkship Administrator at least 8-weeks prior to the start of the clerkship.
  • A lottery may be required if there are more student requests than available positions. Coordination will occur between the Clerkship Administrator and the Office of Rural Medical Education.
  • Two sites are available for Surgery 900 Rural Rotation, McPherson, Kansas and Chanute, Kansas. Each location accepts 1 student per rotation. As additional sites meet mandatory criteria, they will be added to the list of approved sites for rural Surgery 900 rotations.
  • The Clerkship Administrator will obtain approval and then forward to the Office of Rural Medical Education where arrangements will be made and finalized. The administrator for Rural Medical Education will notify participants by e-mail of arrangements.
  • Students selected for rural rotation must meet with the administrator for Rural Medical Education at KU Medical Center and document understanding of the limitations of the rural program (timing and circumstances in which the student would take the "Shelf" exam, etc.)
  • Students must supply a copy of their immunization records in order to do a rural rotation.
  • Students chosen for rural rotation will attend their first 4-weeks at KU Medical Center and the second 4-weeks at the rural location. The rural rotation must occur during the second month of the block.
  • The student taking the rural rotation must be present at KU Medical Center for the first day Orientation, the Mid-Clerkship Feedback Session, the Oral Case Presentation and Exam, and the NBME "Shelf" Examination.
  • The student will complete their Surgery 900 Skills Verification Form filled out as appropriate at the rural site and will turn it in with the end of clerkship documents.
  • The "Clinical Performance Rating" forms are sent electronically and will be completed by evaluating faculty members.
  • Patient encounters should be recorded.
  • Each student is responsible for completing readings associated with the didactics and/or labs according to the JayDocs calendar and the Surgery 900 Didactic Recommended Reading Assignments.
  • Students must attend Orientation at KU Medical Center at the start of any block in which he/she is doing a rotation. If the student is doing a "split" rotation (e.g. the student does one month during November but the second month is not done until July - i.e. one or more months, separate the rotation) then the student must also attend the Orientation at KU Medical Center given for the block in which the second rotation is taken.

Printable Forms

Print and carry with you, turn in at Mid-Clerkship Feedback Session and at the End Of Clerkhip:

SURG 900-Review Card (consists of following forms)

Print, complete, and present to Surgery Education Coordinator at the End Of Clerkship:

Supplemental Forms:

Mission Statement

Mission

The Mission of the Surgery Clerkship at the KU School of Medicine is to provide an environment in which medical students may develop the knowledge, skills, attitude and behaviors necessary in the achievement of the goals of the Graduation Competencies of the KU School of Medicine.

Vision

The Surgery Clerkship will achieve its Mission in an environment in which the student and faculty seek continuous learning, teaching and service. The Surgery Clerkship will use evidence based methods, up-to-date technology and reasonable expectations of faculty and students in its quest to serve the mission.

The Learning Environment

The KU School of Medicine (SOM) is committed to educating students in an environment that fosters optimal learning, a spirit of collegiality, mutual respect, and open communication (i.e. a positive "learning environment"). While the vast majority of KU SOM students experience a positive learning environment, you may either experience or witness events that run counter to this goal. The KU SOM takes violations of our learning environment standards (see web links below) seriously. Any faculty member, the KU SOM administration (specifically the OSA), the Vice Chancellor of Students, or the Equal Opportunity Office can be approached with concerns about mistreatment or an adverse learning environment.

Expectations for the Teacher-Learner Relationship, the Positive Learning Environment and Attributes of Professionalism Policy, KU School of Medicine Policy

Academic Accommodations

It is the policy of KU Medical Center to accommodate students with disabilities, pursuant to federal and state law. Any student with a disability who needs an accommodation, for example in arrangements for exams, note taking, or access to events should contact, Cyn L. Ukoko @ cukoko@kumc.edu, in the Academic Accommodations Services Office (1020C Student Center), 913-945-7035, as soon as possible to better ensure that such accommodations can be implemented in a timely fashion. Online appointments may also be made at https://medconsult.kumc.edu For online information about academic accommodations, please visit the academic accommodation services site.

KU School of Medicine

University of Kansas Medical Center
Department of Surgery
Mail Stop 2005
3901 Rainbow Boulevard
Kansas City, KS 66160
Phone: 913-588-3117