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Core Objectives of the Basic Surgical Clerkship

Knowledge
Skills
Attitudes
Learning Objectives
Surgical Entities to Recognize
General Recommendations
Student Responsibilities
Lectures
Surgical Videos
Preceptorships
Patient Encounter Experience
Surgical Grand Rounds
Surgical Skills Lab
Professor's Hour
Attending Teaching/Walkaounds
Clerkship Attendance Policy
Blackboard/Bulletin Board
Call Schedules
Scrubwear
Dress Code
Infection Control
Tracking Your Work Hours
Surgical Textbooks
Grading/Evaluation of Students
Guidelines for Choosing Evaluators
Mid-Term Feedback Session
Feedback to Students
Feedback from Students
Call Rooms
Surgical Housestaff Lounge
Surgery Interest Groups
Patients, Physician & Society
Research Opportunities
Elective Opportunities
Study Time/Personal Time
Bayview Students
JHU SOM Guidelines for Conduct in Teacher/Learner Relationships
How to Survive and Excel in This Surgical Clerkship
Service Assignments - Where to Report
Top Ten List for the Surgery Clerkship
Medical Education Home

Knowledge

  • Demonstrate knowledge and understanding of common surgical problems
  • Understand the indications for, and the limitations of, essential diagnostic studies used to evaluate patients with surgical problems
  • Demonstrate an understanding of surgical treatments, and alternatives to surgical treatment
  • To become familiar with various surgical procedures and know their expected outcomes and complications
  • Develop cost/risk/benefit appreciation as it applies to patient care
  • Be familiar with action, dosage and use of common pharmacologic agents used in surgery (analgesics, antibiotics, anticoagulants, sedatives)

Skills

  • Evaluate and assess patients with surgical diseases
  • Understand and possibly perform various basic procedures, such as:
    • venipuncture
    • placement of intravenous catheter
    • insertion of urethral (Foley) catheter
    • insertion of nasogastric tube
    • removal of surgical drains
    • closure of surgical incisions
    • removal of suture/staples
    • dressing changes
  • Apply specific protocol in the operating room (scrubbing, gowning, gloving, prepping and draping)
  • Develop specific motor skills utilized in surgery
  • Interpret common laboratory tests (CBC, electrolytes, blood gases, urinalysis, coags)
  • Interpret common radiologic tests (CXR, KUB, UGI, BE, bone, nuclear tests, US, CT)
  • Perform and interpret EKG

Attitudes

  • Acquire a caring and sympathetic attitude appropriate for dealing with patients with surgical illnesses
  • Acquire an appreciation for the collegial interaction necessary to work on the surgical service, in the OR, etc.
  • Realize the scope of responsibility you assume as the surgeon and to that of the family and referring physicians
  • Demonstrate an openness to recognize limitations by using resources referrals and consultation with supervising preceptors or others when appropriate
  • Demonstrate an openness to receive constructive criticism
  • Perform duties within a professional comportment encompassing such areas as attendance, dress code, and general demeanor
  • Respect patient privacy information

Learning Objectives

For each presenting symptom, condition, or disease state, the student should be expected to know:

  • Anatomy
  • Pathophysiology
  • Common associated symptoms
  • Positive physical findings
  • Differential diagnosis
  • Treatment
    • medical/surgical alternatives
    • when treated medically, indications for surgical intervention
    • risk factor assessment
    • pre- and post-operative management
    • complications: recognition and treatment
  • Adjuvant therapies – indications and outcome
  • Prognosis
  • Discharge: timing, patient education, follow-up, resumption of activities

Surgical Entities to Recognize

In addition to the list of potential topics for Professor’s hour outlined on page 15, the student should be familiar with management plans for the following:

  • Intracranial tumors/aneurysm/AVM
  • Lung tumors
  • Renal calculi/masses/cancer
  • Prostate cancer/hypertrophy
  • Shock
  • Burn injuries
  • Pediatric bowel disorders
  • Common orthopedic injuries and tumors
  • Common anesthesia scenarios
  • Common ENT problems
  • Surgical ethics and end of life issues
  • Major milestones in surgical history

General Recommendations

  • It is important to integrate into the surgical team. You are encouraged to follow individual patients throughout their hospital stay
  • It is appropriate to ask questions on rounds, in the OR, etc, regarding patient management
  • Be enthusiastic!
  • Make an effort to be present in the operating room to see the induction of anesthesia, preoperative preparations, and the performance of surgical procedures.
  • Volunteer to write history and physicals, brief op notes, post-op orders, progress notes, and to present patients on morning or afternoon rounds. It is appropriate to follow individual patients more closely than others

Student Responsibilities

Attendance is required at:

  • Lectures
  • Professor’s hour
  • Skills laboratory
  • Preceptor groups
  • Respective general surgery service conference
  • Exams:mid-term written, final written SHELF, standardized patient exam
  • Mid-term feedback session with Dr. Yang
  • Physicians and Society lectures when they occur

When not present at the above, your presence should be in:

  • Operating room
  • Outpatient clinic
  • Non-general surgery service conferences
  • Patient floor work
  • In-house consultation

Lectures

The lectures deal with both general surgery and subspecialty topics. Lectures are given at JHH on Wednesdays, unless otherwise indicated on your schedule.

In most cases, e-lectures have been recorded for the topics. Each night prior to the lecture, you'll need to view the e-lecture for preparation of the following morning. The lecture time will be more of a problem-based discussion on the topic. Handouts for some of the lectures are available on Blackboard. Print them and bring to lecture.

**Prompt attendance at all lectures is expected. The attending staff and resident staff are aware that the lectures are given, and they expect you to attend. Should extenuating circumstances make it impossible for you to attend a lecture, please make arrangements to obtain the lecture notes from a classmate.

Surgical Videos

Selected procedures can be viewed at http://www.eesedu.com/dtcf and the WelchWeb site has video via McGraw-Hill Access Surgery, http://www.accesssurgery.com

Preceptorships (all students)

Each student is assigned to a small Preceptor group with whom he/she will meet once a week during the Surgical clerkship. The individual Preceptors will determine the structure of these sessions, but they are mainly to present common surgical issues in a problem-based Socratic teaching format. This is a time to ask your Preceptor of specific questions you may have. These sessions are mandatory and are not graded. Please check your information packet to see where, when and with whom your first meeting will be held.

Patient Encounter Experience

Interactions with pre-op and post-op patients in an ambulatory setting are a valuable part of each student's general surgery and subspecialty rotation. Due to new national regulations overseeing medical school curriculum, these must be quantified and tracked. You must go online to complete the patient encounter form. A link may be found on the Department of Surgery Halsted site, http://halstedsurgery.org or by logging onto http://oac.med.jhmi.edu.

Patients that should be logged should include those:

  • seen in the outpatient clinic
  • OR cases that you scrub in on
  • in-house consults that you participate on
  • patients who you do a procedure on (e.g. Foley, IV, blood draw)
  • presented during teaching rounds which you learn a teaching point from

You must enter at least 50 patients and must fulfill the required numbers in each of the following areas. These number are easily attainable:

Head and Neck
7 patients required
Brain tumor/mass/cancer/aneurysm, facial lesions, hearing problems, hematoma, hoarseness, paratyhroid/thyroid diseases, laryngeal cancer/mass, neck mass, pituitary, sinusitis, tracheostomy, trauma

Chest
5 patients required
Breast cancer/mass/reconstruction, lung cancer/mass, mediastinal mass, pleural effusion, pneumothorax, respiratory distress/pneumonia, trauma

Cardiovascular
5 patients required
Aortic disease/aneurysm, coronary artery disease, carotid artery disease, DVT/PE, gangrene, heart failure, peripheral vascular disease, vascular access

Gastrointestinal
20 patients required
abdominal pain, adrenal, appendix, bowel obstruction, biliary diseases, jaundice, colorectal cancer/diseases, esophagus, gastric cancer/bypass, peptic ulcer disease, hernias, GI bleeding, inflammatory bowel disease, liver, pancreas, spleen, trauma, organ transplant

Genitourinary
5 patients required
bladder cancer/mass, BPH, foley insertion, ESRD, GYN, hematuria, impotence, incontinence, infection, kidney mass, kidney stones, kidney transplant, prostate cancer, renal cell carcinoma, testicular cancer/mass, urinary urgency

Musculoskeletal
8 patients required
abdominoplasty, amputations, bone fractures/tumors, burns, back pain, soft tissue injuries/tumors, infections, melanoma, neurologic disorders, incisional hernias

Some cases may be entered into more than one category – if one area fills up first during the early stages of the clerkship, use another category to ensure you fulfill all areas. You entries will be tracked weekly during the clerkship – you will be notified by email or pager if you are falling behind. It is best to enter patients on a routine basis rather than waiting to the end. If you have trouble deciding which system to enter patients in, please ask us.

Please remember, you will not be permitted to take the examinations if these areas are not fulfilled. It is therefore important to review your cases periodically and see patients in the areas that are lacking to avoid the inability to fulfill these requirements.

Surgical Grand Rounds (all students)

Surgical Grand Rounds are held in Turner Auditorium/Tilghman Room from 7:00 a.m. to 8:00 a.m. each Thursday. Grand Rounds are an integral part of the surgical teaching program, and attendance is expected. Questions on Grand Rounds topics may be incorporated into the examinations at the end of the surgical clerkship.

Surgical Skills Lab (all students)

The skills lab is offered to all students as an opportunity to practice suture and knot-tying skills and to perform simple surgical procedures. This experience is directed by Dr. Stephen Yang in the U.S. Surgical Minimally Invasive Surgery Training Center (MISTC) on Blalock 12 and held on Wednesday mornings at 9:00 a.m. to noon, immediately following lecture. Consult your handout for your specifically assigned Wednesday sessions. Please be prompt to your session. If you choose not to participate in this lab due to personal or religious beliefs, please contact Dr. Yang immediately to ensure we have the appropriate number of supplies.

Professor's Hour

This is a one hour conference held at 8:00 a.m on Wednesdays in the MISTC conference room (Blalock 1220) for all students – please be prompt and do not wear scrubs. Please read the schedule in your information packet regarding the date of your presentation. In most cases you have been paired and thus are responsible for contacting your partner. You are responsible for choosing a patient with a general surgical problem. Students should turn in the sheet in the information packet with the patient's name and diagnosis to Trisha Arbella (Blalock 240) no later than the Monday prior to your presentation.

If you are the presenter, you are responsible for preparing a brief (10 minute) case presentation including pertinent history, physical examination, and workup with a historical perspective. If you are the discussant, you must present a brief (10 minute) discussion of the pathophysiology and treatment options. However, both students are responsible for the presentation and should know each other’s material.

You will be assigned a grade based on the following components of your presentation. This will count for 5% of your total grade – all grades are final and there will be no challenges to this grade. Each of the following will be on a scale of 1 (worst) to 5 (best).

Delivery: Is the student’s voice clear and strong?
Cogency: Was the information presented clearly?
Organization: Was the topic presented in a logical interesting sequence?
Length: Was the length of the presentation appropriate to the topic?
Subject knowledge: Is there a clear grasp of the information and are questions answeredcorrectly with elaborations?
Preparation: Did the presentation evidence care in its preparation?

Attending Teaching/Walkarounds

Varies by service

Clerkship Attendance Policy

As outlined in the Johns Hopkins School of Medicine policy, students are not allowed to miss more than 3 full days of responsibilities as excused absences. Any days away from the clerkship must be documented and approved by Dr. Yang. If students do not contact the course director in advance of any absences, they will be considered unexcused and will impact on the student’s final grade. All absences due to sickness, must be called into Trisha Arbella (410) 502-5062 or emailed the same day as the absence. Also, students are required to contact their team to let them know of the absence. All students who miss more than the allowed days above will be required to develop a plan for remediation of missed days with the clerkship director. Such remediation is a necessary requirement for successful graduation from the M.D. curriculum.Students are responsible for any lectures, teaching sessions, etc. which are missed during their time away. Ifastudentneeds a particular weekend off,the call schedulemustbearrangedwith your individual team.

Blackboard/Bulletin Board

Consult Blackboard DAILY for announcements, etc. Pertinent announcements and any changes in the lecture schedule will be posted here, on Blackboard. No emails or pages will be sent out to notify you!!

Call Schedules

The call schedule for the general surgery and surgical subspecialty components of the Basic Surgery Clerkship will be no more rigorous than everyfourth night "on call" in house. There is some flexibility in the call schedules. Best is to take call with your team.

Scrubwear

Green scrubwear is made available for “authorized users” in operating rooms, labor and delivery, cath lab, etc. You are “authorized users” for your time on the Basic Surgical Clerkship. Your I.D. badge will activate the autovalet system. You must return one pair of scrubs in order to be dispensed another pair. Scrubwear may be worn in the hospital buildings, but must be covered by a tied cover gown or a buttoned white lab coat when outside of the Operating Room sterile areas. You may not wear the green scrubwear out of the hospital . . . for any reason! Security personnel will stop any individual entering or leaving the hospital in authorized green scrubwear. Names of individuals not complying with the scrubwear regulations will be submitted to the Department Chairman for action.

Dress Code

Appropriate professional attire must be worn during all clerkship activities. This includes proper grooming, bathing and lack of distracting jewelry or body piercing. Lab coats must be worn during all patient encounters. Inappropriate appearance will be reported to Dr. Yang and to the Dean’s office.

Infection Control

The following steps are to be followed when a student has experienced an exposure to blood or bloody/infected body fluids, a needle stick, cut or puncture wound, a mucous membrane splash, or a cutaneous exposure, especially if the skin is broken:

  • Wash the exposed site immediately
    • If needle stick, cut, puncture wound, or cutaneous exposure, wash with soap and water, alcohol, betadine or other cleansing agent
    • If splash to eyes or mount, flush with clear water
  • Inform supervisor or charge person as soon as possible with the incident
  • Call 5-STIX immediately and report the incident. You may have to go to their office immediately. Remember to bring important patient information (name, number, DOB)

Tracking Your Work Hours

On a weekly basis, student's work hours in the hospital must be recorded. The only limitation for works hours by the national Liaison Committee for Medical Education is that students should not work more than the residents. There are no rules for leaving early post call - this will be left to the discretion of each service. Since Sundays in general are free, this will count as the student's weekly day off, unless the student decides to take call that day.

Wewill be tracking these hours and informing students by email and pager, should we find you are not complying with this. The website for hour tracking is http://halstedsurgery.org or https://halstedsurgery.org/WKL_TimeSheet.asp. You will not be allowed to sit for the SPE or written exam if you fail to complete your work hour log.

Surgical Textbooks

Recommended:

Essentials of General Surgery 4th edition; Peter F. Lawrence; Williams & Wilkens; 2006; $54.95.

Essentials of Surgical Specialties 3rd edition; Peter F. Lawrence; Williams & Wilkens; 2007; $49.95.

Grading/Evaluation of Students

A letter grade is transmitted to the Registrar's office approximately 6-8 weeks after the clerkship has been completed.The grading system will be Honors, High Pass, Pass, Fail, and Incomplete.

The components of your final grade include:

General surgery evaluation—30%
Subspecialty 1 evaluation—15%
Subspecialty 2 evaluation—15%
Written SHELF Exam—25% ** MUST PASS
Standardized patient exam—10%
Professor’s hour score—2.5%
Mid-term written exam—2.5%

The written evaluations based on your clinical performance are filled out at the completion of each rotation by no more than a total of 4 (2 from attendings and 2 from residents) evaluators of that service.The final grade for each rotation willbe a composite score of these evaluations. You are score on a scale of 1 (bad) to 5 (superior) on the following categories:

  • Clinical knowledge
  • Self Directed Learning
  • Data Gathering (History/Interviewing)
  • Physical Exams
  • Problem Solving
  • Clinical Judgement
  • Responsibility/Reliability
  • Integrity (based on 1-3 scale)
  • Compassion
  • Respectfulness
  • Response to feedback
  • Communication with Patients
  • Communication with Colleagues
  • Oral Patient Presentation
  • Clinical Data (Ability to record clinical data)
  • Procedural and Technical Skills

Guidelines for Choosing Evaluators

- At the beginning of the rotation you will be assigned an evaluation via eValue, entitled “Who Did You Work With”, to choose four people that you have worked with, that you would like to evaluate you.
- You must choose at least 2 faculty and up to 2 residents per service for each rotation. These evaluators MUST be chosen all at the same time.
- THEY MUST BE JOHNS HOPKINS FACULTY OR RESIDENTS. Residents outside the Departments of Surgery (e.g. anesthesia) or rotating from other institutions/hospitals are NOT eligible
- All evaluators should be asked by the student prior to being selected. Evaluators must be assigned on or before the last 3 days of the rotation, so that the evaluations can be completed in a timely manner.

Failure to choose evaluators from a rotation in a timely fashion, will result in a failing score for that particular service.

The NBME Shelf Exam is a 100 question multiple choice written examination given to test your knowledge of surgical diseases and treatments. Questions on the written examination are not based on specific individual lectures directly, but rather on topics within the broad field of general surgery and subspecialties. You will have 2 hours and 10 minutes to complete it. You will be required to pass this exam in order to pass the clerkship. Failure to do so will result in a grade of Incomplete (I) submitted to the Registrar’s office and a brief discussion of your performance at the Dean’s 3rd and 4th year Promotions Committee meetings, held periodically through the academic year. You will not be eligible for honors as a final grade, if you fail the Shelf exam. It will be your responsibility to contact Dr. Yang for remedial work to include independent reading, homework quizzes, and to retake the Shelf Exam. If the Shelf Exam is failed again, a failure (F) grade for the entire clerkship will be reported, and the entire clerkship would need to be repeated again. Failing the NBME exam will automatically disqualify your clerkship grade from honors status, regardless of your score on the second exam.

The mid-term exam is an on-line exam made up of 50 Shelf-like questions, covering lecture topics given to that point. You will have one hour and 30 minutes to complete it. The exam is placed on the Halsted site, under the medical student icon, “exams”. The exam is able to be taken between 6:00 a.m. and 5:30 p.m. on the designated day. We encourage students to take this exam during the morning hours either before or after the SPE portion. Students should report back to their teams immediately following both. In the event that both exams can not be taken before noon, the students are responsible for asking the teams permission to take the on-line exam in the afternoon. Students must begin the exam by 4:00 p.m. because the final report will be ran for the grade calculations at 5:30. Any questions not completed by that time, will receive zero points.

The purpose of the SP examination is to evaluate your ability to gather clinical data and to solve 4 clinical problems. These patient models will present common surgical issues that are covered during the surgical clerkship. This exam is given over a period of 2 days, viewing 2 patients per day. The first session will be during your mid term exam day, the second session will follow your NBME exam. During the mid term SPE, students will receive feedback after their performance. Dr. Yang will provide additional feedback from the post encounter forms, during your feedback sessions.

Grades and evaluation forms submitted to the Registrar’s Office are considered final. Grades are hardly ever negotiated. In extraordinary circumstances, grade change requests are directed in writing to Dr. Yang. You will have one month after the final grades are posted to request a grade change inquiry. It is not appropriate to ask individual faculty or housestaff to change a grade. An overall Failure (F) grade mandates that the entire clerkship be repeated again. A Failure (F) grade in any of the components of the final grade would necessitate presentation and discussion at the Dean’s Promotions Committee.

Mid-Term Feedback Session with Dr. Yang

Students will have a 10 minute formative feedback session with Dr. Yang in his office after half of the clerkship is over. During this time, Dr. Yang will review any evaluation forms from the completed rotations, and available grades from the mid-term exam and Professor’s hour. This time will providethestudentwithan opportunity to discuss anyproblems or issues, and inquire about Surgery as a possible career option. A summary of the meeting will be dictated by Dr. Yang and placed inyoursurgery folder. A schedule of these meetings is included in your packet.

Feedback to Students

Faculty and residents are encouraged to provide students with regular constructive feedback on their performance throughout the clerkship. As a means of facilitating this process, students are encouraged to regularly solicit feedback from their preceptors regarding their performance. Questions like “How did I do today” or “Is there anything specific that you’ve noticed that I could do better?” will help prompt supervising physicians and associated medical care staff to provide important constructive feedback.

Feedback from Students (Student Evaluation Forms/Website)

We have made an ongoing effort to evaluate the Basic Surgical Clerkship over the years. We rely on evaluations from your experiences during the Surgical Clerkship to help us modify and improve the clerkship.

These evaluation forms will be available on line with E-Value. Students are asked to complete these final evaluation forms carefully, no later than6:00 p.m. on theWednesday afternoonprior to your study day.You will not be permitted to take the examinations if your final evaluation forms are not completed and submitted via eValue.

All evaluations are anonymous, so we want you to be as honest and specific as possible (including names and particular issues). Service attendings will not see your comments until all grades have been submitted for their rotations, so your evaluations will not affect your rotation grades. Dr. Yang is the only one who has access to all comments, but not the name of the evaluator. Ms. Arbella has access to the names of the students who have filled out evaluations, but does not have access to the comments.

Call Rooms

There may be designated call rooms for each service. However, staying with the resident in the same call room overnight is left up to the discretion of both the student and the resident. We have 2 call rooms designated for the surgery clerkship students on Weinberg 3, room 3461. The access code is 2416*. The call rooms next to the Doctors' Lounge on the first floor in the hallway by the entrance is also available on a first come first serve basis.

Surgical Housestaff Lounge (Harvey 7)

May be used by students at invitation of appropriate house officer.

Surgery Interest Group

These meeting will be held monthly. Please check the Halsted website for dates, times and speaker information.

Patients, Physician & Society

Mandatory attendance - Be there!

Research Opportunities

Available, including laboratory and clinical projects.

Elective Opportunities

Available, including advanced clerkships and subinternships.

Study Time/Personal Time

Sundays, evenings and other, as available.

Bayview Students

On the first day on the Bayview Campus, you can park in the VISITOR PARKING GARAGE. Swipe your badge to check for access, if none was granted please pull a ticket and Sabrina Mercer will give you a parking voucher for that day. Enter via the Bayview Medical Office entrance (BLUE CANOPY). The surgery offices are located on the 5th floor of the A Building, ask the security officer at the Reception Desk for directions to the YELLOW ELEVATOR. Take the elevator to the 5th floor, exit and come to General Surgery Administrative offices on the right.

The Johns Hopkins University School of Medicine Guidelines for Conduct in Teacher/Learner Relationships

I. Statement of Philosophy

The Johns Hopkins University School of Medicine is committed to fostering an environment that promotes academic and professional success in learners and teachers at all levels.The achievement of such success is dependent on an environment free of behaviors which can undermine the important missions of our institution.An atmosphere of mutual respect, collegiality, fairness, and trust is essential.Although both teachers and learners bear significant responsibility in creating and maintaining this atmosphere, teachers also bear particular responsibility with respect to their evaluative roles relative to student work and with respect to modeling appropriate professional behaviors.Teachers must be ever mindful of this responsibility in their interactions with their colleagues, their patients, and those whose education has been entrusted to them.

II. Responsibilities in the Teacher/Learner Relationship

A. Responsibilities of Teachers

  1. Treat all learners with respect and fairness.
  2. Treat all learners equally regardless of age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation.
  3. Provide current materials in an effective format for learning.
  4. Be on time for didactic, investigational, and clinical encounters.
  5. Provide timely feedback with constructive suggestions and opportunities for improvement/remediation when needed

B. Responsibilities of Learners

  1. Treat all fellow learners and teachers with respect and fairness.
  2. Treat all fellow learners and teachers equally regardless of age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation.
  3. Commit the time and energy to your studies necessary to achieve the goals and objectives of each course.
  4. Be on time for didactic, investigational, and clinical encounters.
  5. Communicate concerns/suggestions about the curriculum, didactic methods, teachers, or the learning environment in a respectful, professional manner.

III. Behaviors Inappropriate to the Teacher-Learner Relationship

These behaviors are those which demonstrate disrespect for others or lack of professionalism in interpersonal conduct. Although there is inevitably a subjective element in the witnessing or experiencing of such behaviors, certain actions are clearly inappropriate and will not be tolerated by the institution.These include, but are not limited to, the following:

  • unwanted physical contact (e.g. hitting, slapping, kicking, pushing) or thethreat of the same;
  • sexual harassment (including romantic relationships between teachers and learners in which the teacher has authority over the learner’s academic progress) or harassment based on age, gender, race, ethnicity, national origin, religion, disability or sexual orientation;
  • loss of personal civility including shouting, personal attacks or insults,displays of temper (such as throwing objects);
  • discrimination of any form including in teaching and assessment based upon age, gender, race, ethnicity, national origin, religion, disability, or sexual orientation;
  • requests for others to perform inappropriate personal errands unrelated to the didactic, investigational, or clinical situation at hand;
  • grading/evaluation on factors unrelated to performance, effort, or level of achievement.

IV. Avenues for Addressing Inappropriate Behavior in the Teacher/Learner Context

A. Learners' Concerns

Learners may address situations in which they feel that they have been the object of inappropriate behavior at various levels. At the most basic level, the most effective way to handle a situation may be to address it immediately and non-confrontationally. Oftentimes, a person is simply unaware that his/her behavior has offended someone, or even if aware, will correct the behavior appropriately if given the opportunity to do so in a way that is not threatening. The way to raise such an issue is to describe the behavior factually (“When you said…”), describe how the behavior made you feel (“I felt …”), and state that the behavior needs to stop or not be repeated (“Please, don’t do that again.”)

Sometimes, such a request is not successful, or the person repeats the behavior, or the learner does not feel comfortable speaking directly to the teacher about his/her behavior. In those cases, it may be helpful to discuss the behavior with course directors, laboratory mentors, program directors, or department chairs. Students may also elect to speak to their respective Associate or Assistant Deans for informal advice and counsel about these issues. These individuals may offer additional suggestions for resolving the matter informally, such as, for example, speaking to the individual on the learner’s behalf or on behalf of an entire class, raising the general issue in a faculty meeting, assisting the learner with writing to the individual teacher or even direct intervention to get the behavior to stop.

If no satisfactory resolution is reached after these discussions or the learner does not feel comfortable speaking to these individuals, he/she may bring the matter formally to the attention of the School of Medicine administration. The avenues for this more formal reporting vary depending upon the status of the reporting individual.

  1. If the person reporting the behavior is a medical student:
    • The student should speak with one of the Associate or Assistant Deans in the Office of Student Affairs.
  2. If the person reporting the behavior is a graduate student or M.D./Ph.D. student pursuing their graduate studies:
    • The student should speak with the Associate Dean for Graduate Student Affairs and/or the Director of the M.D./Ph.D. program.
  3. If the person reporting the behavior is a post-graduate trainee (i.e. resident or clinical fellow):
    • The trainee should speak with the Associate Dean for Graduate Medical Education.
  4. If the person reporting the behavior is a research fellow:
    • The trainee should speak with the Associate Dean for Postdoctoral Affairs.

B. Teachers' Concerns

If a teacher feels that a learner has engaged in inappropriate behavior, it is likewise most effective to address the situation immediately and non-confrontationally. If the matter is not resolved satisfactorily, the teacher should contact the course director, program director, or laboratory mentor to discuss the matter. If the teacher wishes to make a formal allegation of misconduct, they should contact the following members of the administration:

  1. If the matter involves a medical student, contact the Associate/Assistant Dean for Student Affairs;
  2. If the matter involves a graduate student, contact the Associate Dean for Graduate Student Affairs;
  3. If the matter involves a postgraduate trainee, contact the Associate Dean for Graduate Medical Education;
  4. If the matter involves a research fellow, contact the Associate Dean for Postdoctoral Affairs.

These allegations will be handled according to established School of Medicine policies published elsewhere.

V. Procedures for Handling Allegations of Inappropriate Behavior in the Teacher/Learner Context

A. Upon being notified of alleged inappropriate behavior, the Associate or Assistant Dean will notify senior administration officials in a written report within 5 business days of the allegation as follows:

  1. If the complaint is lodged against a faculty member, the Vice Deans for Education and Faculty will be notified. Other than those matters referred to the Office of Equal Opportunity and Affirmative Action Programs, the matter will be handled in accordance with the School of Medicine’s Procedures for Dealing with Issues of Professional Misconduct.
  2. If the complaint is lodged against a post-graduate trainee, the Vice-Dean for Education and the Associate Dean for Graduate Medical Education will be notified. If the complaint is lodged against a research fellow, the Vice Dean for Education and the Associate Dean for Postdoctoral Affairs will be notified. Other than those matters referred to the Office of Equal Opportunity and Affirmative Action Programs, if based on the written report, those Deans decide that a formal investigation is merited, they will convene an ad hoc committee to investigate the complaint and will notify the complainant, the respondent and appropriate department chairs and program directors of such an action. The ad hoc committee will be composed of three faculty members from departments other than those of the complainant or respondent. The committee will be responsible for gathering information and interviewing the complainant, respondent, and other individuals as they deem appropriate. Based upon information gathered and their deliberations, the committee will submit a written report to the Deans involved within thirty days from when they were convened which will include their findings and recommendations for dismissal of the complaint or for disciplinary action(s). The senior Deans will then communicate to the complainant and respondent in writing that a determination has been made. If the committee finds against a post-graduate trainee, the findings will be communicated to the appropriate Department Chair and Program Director and sanctions will be determined and enforced according to the policy on Probation, Suspension, and Termination of Post-Doctoral Fellows published elsewhere which also includes an avenue of appeal.

B. If the behavior involves unlawful discrimination or sexual or other forms of unlawful harassment, the matter will be referred to the Office of Equal Opportunity and Affirmative Actions Programs and be handled through University policies established for that office. The student may also directly contact that office.

C. If the behavior involves unwanted physical contact or other forms of violent or threatening acts, the matter may be referred for evaluation under the University’s Policy Addressing Campus Violence.

D. The School of Medicine is committed to the fair treatment of all individuals involved in this process. All efforts will be made to maintain the confidentiality of the resolution process to the extent possible and subject to the overriding concern of a prompt and fair investigation and/or resolution of the complaint.

E. The School of Medicine will not tolerate any form of retaliatory behavior toward learners who make allegations in good faith. Individuals who believe that action has been taken against them in retaliation for raising concerns under this policy, may address those concerns through the procedures described in this policy.

F. Records of all communications as well as the written reports of the Associate Deans and ad hoc committee will be kept in the Office of the Vice Dean for Education.

G. If it is determined that the allegations from the complainant were not made in good faith, the student or post-graduate trainee will be referred for disciplinary action under the appropriate University procedures which are described elsewhere.

How to Survive and Excel in this Surgical Clerkship

  • Problem 1 - What exactly is my role? What are the expectations?
    • Ask your faculty or residents what your role is
    • Be a student; read; prepare
    • Beware loss of defined daily structure (compared to preclinical years)
    • Know your ward, operating room, clinic responsibilities
  • Problem 2 - There is not enough time to read. (How to manage overload).
    • Develop a reading plan (eg - read 24 substantive chapters in Lawrence, 8 weeks, 3 per week)
    • Read about next day’s cases
    • Recognize that you can’t read it all
  • Problem 3 - I am getting little or no feedback.
    • You desire descriptive, specific and timely feedback
    • It is acceptable to ask for feedback
  • Problem 4 - I have no life, and I am stressed to the max!
    • Stress management principles: eat sensibly, exercise, self-care, find a confidant/family/friends
  • Problem 5 - What does it take to be an Honors student?
    • Intellectual curiosity - read appropriately, ask questions
    • Be a team player
    • Fluent, dynamic presentations
    • Use information-seeking skills, MEDLINE, etc.
    • Be available and enthusiastic on call nights
    • Demonstrate operating room enthusiasm

Service Assignments - Where to Report

JHH/General Surgery

At the conclusion of the orientation this morning, students should assemble together in groups based upon their assignments, (Cameron, Ravitch, Halsted, Handlesman), contact the paging operator (x 5-5020), ask for the name and beeper number of the house officer on call, and meet with this house officer to discuss the service, the on-call schedule, and the patients.

JHH/Specialty Rotation

Cardiac Surgery - Report to Dr. Shah’s office (Blalock 618)
Neurosurgery - Report to Dr. Huang’s office (Meyer 8-181)
Otolaryngology - Report to Dr. Pai’s office (JHOC- 6th floor)
Orthopedic Surgery - Report to Dr. Laporte’s office (JHOC - Suite 5210)
Pediatric Surgery - Report to Dr. Colombani's office (Harvey 319)
Plastic Surgery 
Thoracic Surgery - Report to Dr. Yang’s office (Blalock 240).
Transplant Surgery - Report to Dr. Cameron’s office (Ross 765).
Urology - Report to Mary Nori’s Office (Marburg 143).
Vascular Surgery - Report to Dr. Perler’s office (Harvey 611).

Bayview: Dr. Steele will meet with all students assigned to Bayview in the Surgery Conference Room (A5 Center) for an orientation. Please see Sabrina Mercer in the Department of Surgery for information on this meeting, service assignments, parking and scrub access immediately following your orientation here today.
Sinai Hospital of Baltimore: Dr. Genuit will meet with those of you assigned to Sinai. Please see Jean Sturdivant. She is located in the Hoffberger Building, suite 42.

The Top Ten List for the Surgery Clerkship

  1. Read all objectives for the clerkship, for each rotation, and for each lecture.
  2. Be prompt for all lectures and conferences – be aware of schedule dates/time and changes
  3. The Professor’s hour topic sheet must be turned in no later than the Monday before your presentation.
  4. You must stay current with entering your Patient Tracker and work hours on line.
  5. You must enter at least 50 patient encounters with specific organ requirements.
  6. You will not be allowed to sit for the written or SP exam without completing Patient Tracker information, work hours, and all of the Clerkship evaluation form.
  7. You must pass the NBME Shelf written exam to pass the clerkship.
  8. E-Lectures should be reviewed either via the Halsted site or Blackboard the evening prior to the scheduled lecture time.
  9. Grades are hardly ever changed
  10. Have fun!