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Orientation

ORIENTATION TO SURGERY

OBJECTIVES OF THE BASIC SURGICAL CLERKSHIP :

A.) KNOWLEDGE:

  1. Demonstrate knowledge and understanding of common surgical problems
  2. Understand the indications for, and the limitations of, essential diagnostic studies used to evaluate patients with surgical problems
  3. Demonstrate an understanding of surgical treatments, and alternatives to surgical treatment
  4. Become familiar with various surgical procedures and know their expected outcomes and complications.

B.) SKILLS:

  1. Evaluate and assess patients with surgical diseases
  2. 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

C.) ATTITUDES:

  1. Acquire a caring and sympathetic attitude appropriate for dealing with patients with surgical illnesses
  2. Acquire an appreciation for the collegial interaction necessary to work on the surgical service, in the OR, etc.

GENERAL RECOMMENDATIONS

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

LECTURES:

  1. Morning lectures: These are given at each of the hospitals to which students rotate.  The morning lectures deal with general surgical and subspecialty topics.
  2. Afternoon lectures: On Thursdays, lectures are given following Professor's Hour.

 ** Attendance at both the morning and afternoon lectures is expected.  The attending staff and the resident staff are aware that the morning and afternoon 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.

AMBULATORY EXPERIENCE:

Interactions with preop and postop patients in an ambulatory setting will be a variable part of each student's general surgery and subspecialty rotation.  Please see the attached general surgery clinic schedule for specific information pertinent to your general surgery clinic assignments.  Patients should be logged into the Patient Tracker systemfor each clinic that you attended. 

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. Please check your information packet to see where, when, and with whom your first meeting will be held.

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.

PIG LAB (EXPERIMENTAL SURGERY COURSE) (all students):

The pig 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 will  be offered on Wednesday's from 9:00 a.m. - 1:00 p.m..  Consult your student packet for your specifically assigned Wednesday sessions. 

OPERATING ROOM TECHNIQUE COURSE (all students):

An orientation to operating room technique is scheduled for all students following their clerskhip orientation

PROFESSOR'S HOUR:

This is a one hour conference held at 11:00 a.m. on Thursdays in the Finney Room (Harvey 829) for all students.  Please read the schedule in your information packet regarding the date of  your presentation.  You are responsible for choosing a patient with a general surgical problem, preparing a brief (10 minute) case presentation including pertinent history, physical examination, and workup, as well as a brief discussion of the topic.  Hopkins students should turn in the patient's name and diagnosis to Trisha Arbella, in Blalock 240 no later than the Monday prior to your presentation (use the form provided in your packet).

ATTENDING TEACHING/WALK ROUNDS:

Varies by service.

SURGICAL RESIDENT TEACHING SESSIONS:

Residents in lab will contact you.

SURGICAL TEXTBOOKS: (prices may vary)

Recommended:

Essentials of General Surgery 3rd edition; Peter F. Lawrence; Williams & Wilkens; 2000; $45.95. 

Essentials of Surgical Specialties 2nd edition; Peter F. Lawrence; Williams & Wilkens; 2000; $45.95 (Both Essentials books are also sold as a package deal for $79.95).

Other:

Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 16th edition; ed: Townsend; WB Saunders; 2001; $131.  A classic textbook.  Companion handbook available, 2002, $41.95.  Review book $41.95. 

Principles of Surgery, 7th edition; ed. S.I. Schwartz; McGraw-Hill; 1999; $147 (For 1 volume edition); $167 (for 2 volume set). Companion handbook available - $47.

Current Surgical Diagnosis & Treatment 11th edition; ed. L. Way; Lange; 2003, $61.95. 

Current Surgical Therapy - 7th ed.   J.L. Cameron; Mosby Yearbook, Inc.; 2001; $161.  A book dealing with up-to-date treatment of common surgical diseases.

Surgical Decision Making 4th edition; ed. L.W. Norton and B. Eiseman; WB Saunders; 2000; $101.  A book of treatment algorithms. 

Cope's Early Diagnosis of the Acute Abdomen 20th edition; W. Silen; Oxford; 2000; $36.50.  A classic book on the acute abdomen. 

Mont Reid Surgical Handbook 4th edition; ed. Berry; Mosby; 1997; $48.95

Surgical Secrets 5th edition; ed. C.M Abernathy and A.H. Harken; Hanley & Belfus; 2004; $36.95.

BLACKBOARD/BULLETIN BOARD:

Consult Blackboard at http://courses.med.jhmi.edu/ for announcements, etc.  Pertinent announcements and any changes in the lecture schedule will be posted on Blackboard.

CALL SCHEDULES:

The call schedule for the general surgery and surgical subspecialty components of the Basic Surgery Clerkship will be no more rigorous than every sixth night "on call", with a maximum of one long "on call" night per week and one short “on call” night per week.  There is some flexibility in the call schedules.

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 covergown 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.

GRADING/EVALUATION OF STUDENTS:

A letter grade is transmitted to the Registrar's office approximately 6 weeks following the conclusion of the Basic Surgical Clerkship.  Grades will be available through the Registrar's office.  The grading system will be H, HP, P and F.  One-third of your grade is based on your clinical performance on the general surgery rotation, and each of the two surgical sub-specialty rotations comprise one-sixth of your grade.  One-third of your grade is based upon the written and standardized patient (SP) examinations. 

The purpose of the written examination is 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 surgery.  The NBME Shelf Exam is used.  The purpose of the SP examination is to evaluate your ability to gather clinical data and to solve clinical problems.

After grades and evaluation forms are made available in the Registrar’s Office, they are considered final.  Grades are not typically negotiated.  In extraordinary circumstances, requests to have a grade changed (elevated from P - HP, etc.) will need to be directed in writing to the Course Director (Dr. Yang).  It is not appropriate to ask individual faculty or housestaff to change a grade. 

HOW TO SURVIVE AND EXCEL IN THIS SURGICAL CLERKSHIP:

 Problem 1 - What exactly is my role?  What are the expectations?

  • 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

STUDENT EVALUATION FORMS:

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.

Evaluations are electronically generated through evalue.  You will complete one evaluation for each rotation you are assigned, one for the lecture series and one for the overall clerkship.  You will not be permitted to take the examinations if your Final Evaluation Forms, Patient Tracker and Time tracker are not completed.

PHYSICIAN & SOCIETY:

Be there!

SURGICAL HOUSESTAFF LOUNGE (Harvey 7):

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

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.

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