Download student principles of surgery lecture schedule

PRINCIPLES OF SURGERY LECTURE SCHEDULE
(Block 4)
Rotation January 3, 2012 to February 24, 2012
Tuesday, January 3, 2012
ROOM 6065
7:30-8:00 AM
WOUND HEALING
Blum
8:00-8:45 AM
Lunch
Surgery Orientation
Meade/Reed
Hemorrhagic Shock Duchesne
Break/
8:45 –9:00 AM
Fluid and Electrolytes
Paramesh
NUTRITION
Schwartz
9:00-10:00 AM
10:00-11:00 AM
11:00 AM – 12:00 Noon
12:00 PM – 1:00 PM
Acute Abdomen/Procedures Consult 1:00-2:00 PM
Jaffe/Volo
Surgical Infection
2:00-3:00 PM
Chaly
Practical Information for Medical Students
Unruh/Long
3:00-3:30PM
Wednesday, January 4, 2012
7:00 – 7:45 AM OR Orientation
Nicole Morrill, RN (Room 6065)
8:00-10:30 AM Lunch
Neonatal Physiology
Steiner
TEAM
Meade
Room 6065
Break
10:30-10:45 AM
11:30 AM-1:00 PM
Suturing/Knot Tying/Foley Cath
NG Tube and IV/Lap Skills Endoscopy
Sim Center (Murphy Bldg)
1:00-4:00 PM
Lecture Test – Thursday, January 5, 2012– Room 6065 at 8:00 AM
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10:45-11:30 AM
LABS – Wednesday, January 4, 2012
ROOM 6065
TEAM 8:00-10:30 AM CS COT’s version of ATLS for medical students, called TEAM (Trauma Evaluation and
Management), consist of lecture and 3 rotation stations.
Group 1
Archer, Benjamin
Dooley, Erin
Darconte, Mary
Garstka, Meghan
German, David
Hayes, Justin
Moak, Joseph
Wash, Erin
Welsh, Leonard
Group 2
Group 3
Barthelemy, Andre
Chen, Thomas
Guice, Jordan
Hartman, Katharine
Hodnette, Christopher
Neeland, Marc
Whiting, Curtis
Yuan, Jennifer
Chang, Olivia
Denson, Aaron
Finkbeiner, Brandon
Halstead, Michael
Khan, Taimur
Padway, Shelby
Swann, Forrest
Yonge, John
OR orientation 10:45 – 11:30 AM - Room 6065 w/ (OR Nurse)
OR Orientation: You are part of a surgical team whose main objective is to provide quality patient care in a safe
environment for staff and patients. Certain tasks seem mundane but each of us has a significant role and responsibility to
meet this purpose. Since OR’s vary, you are responsible for following policies/procedures of the hospital to which you are
assigned.
Your Responsibilities: Come prepared with the knowledge of surgical procedure, anatomy and patient history. You will be
asked to assist with positioning, prepping and possibly draping. If not, once gowned and gloved, stand on the sterile field
side of the room. Please wear clean Tulane green scrubs in the Operating Suites at Tulane.
Stations:
ALL BELOW TRAINING WILL BE DONE ON THE 3RD FLOOR OF THE SIMULATION CENTER AT THE MURPHY BUILDING .
Suturing & Knot Tying w / Honor’s Surgery Students in the CLASSROOM.
(See Key Suturing and Knot tying elements in the handout portion of the website) The Sim Center now
has a YouTube Channel and all the Surgery Clerkship videos are published there and accessible by anyone.
http://www.youtube.com/user/TulaneSimCenter
Foley cath, NG Tube and IV insertion w/Dr. Chrissy Guidry in the PATIENT EXAM ROOM
Lap Skills w/Cheri Touchard in the LAPAROSCOPIC LAB
11:30-1:00
1:00-2:00
2:00-3:00
3:00-4:00
Suturing/
Knot Tying
Foley Cath
(2 models); NG Tube
and IV
Lap Skills/
Endoscopy
LUNCH
Group 1
Group 3
Group 2
LUNCH
Group 2
Group 1
Group 3
LUNCH
Group 3
Group 2
Group 1
Lap Skills: You may be asked to observe or assist in laparoscopic cases during your clerkship. The skills you will practice in
the lab help you better understand the technology and techniques of laparoscopy.
Foley Cath, NG Tube and IV Insertion: While also a required procedure for students to perform, Foley catheters, NG tube
and IV insertion are regularly used in operating rooms and represent another way in which students can be involved in patient care,
as well as being very helpful to the residents and staff.
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Pre-surgery Lecture Test, Thursday, January 5, 2012 from 8:00 – 9:00 AM in room 6065. Meet your team following the test, but
confirm logistics the day before.
OLOL and Baton Rouge students will take their test at those sites; therefore you will arrive at those sites on Thursday, January 5, 2012.
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01/05/12 – 01/29/12
TMC Hepatobiliary
Ochsner 1
Pediatric Surgery Childrens
TMC VEP
Breast Surgery Lakeside
University Trauma
Ochsner 2
TMC VA
TMC VA
TMC Acute Care
TMC Acute Care
TMC Hepatobiliary
University Trauma
Ochsner 3
OLOL 2
TMC Hepatobiliary
University Trauma
OLOL 3
Ochsner 4
TMC Acute Care
TMC VEP
Pediatric Surgery Childrens
BR General
BR General
BR General
NAME
Archer, Benjamin
Barthelemy, Andre
Chang, Olivia
Chen, Thomas
Denson, Aaron
Dooley, Erin
Finkbeiner, Brandon
Garstka, Meghan
German, David
Guice, Jordan
Halstead, Michael
Hayes, Justin
Hodnette, Christopher
Khan, Taimur
Moak, Joseph
Neeland, Marc
Padway, Shelby
Swann, Forrest
Welsh, Leonard
Whiting, Curtis
Yonge, John
Yuan, Jennifer
Mary Darconte
Katharine Hartman
Erin Wash
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01/30/12 - 02/22/12
University Trauma
TMC VEP
University Trauma
Ochsner 1
TMC Acute Care
TMC VA
TMC Hepatobiliary
University Trauma
Pediatric Surgery Childrens
Ochsner 4
TMC VEP
Ochsner 2
Pediatric Surgery Childrens
TMC Acute Care
TMC Acute Care
Ochsner 3
Breast Surgery Lakeside
TMC VA
TMC Hepatobiliary
OLOL 2
OLOL 3
TMC Hepatobiliary
BR General
BR General
BR General
Department of Surgery
January 5, 2012 to February 22, 2012
HOSPITAL
Trauma
TMC/Acute Care
TMC/VA
TMC/VEP
Pediatric Surgery
Children’s
TMC Hepatobiliary
Transplant
Breast Surgery
(Lakeside)
Ochsner 1
Ochsner 2
Ochsner 3
Ochsner 4
OLOL 2
OLOL 3
01/05/12 – 01/29/12
Erin Dooley
Christopher Hodnette
Shelby Padway
Jordan Guice
Michael Halstead
Curtis Whiting
Meghan Garstka
David German
Thomas Chen
John Yonge
Olivia Chang
Jennifer Yuan
Benjamin Archer
Justin Hayes
Marc Neeland
Aaron Denson
01/30/12 - 02/22/12
Benjamin Archer
Olivia Chang
Meghan Garstka
Aaron Denson
Joseph Moak
Taimur Khan
Erin Dooley
Forrest Swann
Andre Barthelemy
Michael Halstead
David German
Christopher Hodnette
Brandon Finkbeiner
Leonard Welsh
Jennifer Yuan
Shelby Padway
Andre Barthelemy
Brandon Finkbeiner
Taimur Khan
Leonard Welsh
Joseph Moak
Forrest Swann
Thomas Chen
Justin Hayes
Marc Neeland
Jordan Guice
Curtis Whiting
John Yonge
Students will be expected to attend clinic 1 day a week with a faculty member of your team; the residents will make those
assignments!
CONTACT INFORMATION ON FOLLOWING PAGE
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CHIEF RESIDENTS:
Name
Children’s Peds (Steiner)
Max Trahan, MD (January 1-6)
504.584-6393
Christopher Martin, MD (January 7-Mar)504.582-9734
LAKESIDE (Dr. Jones)
Kira Long, MD (January 1-6)
Ryan Couvillion, MD (January 7-31)
Mary Ghere, MD (February)
504.538-2635
504.423-4727
504.213-0267
TMC/ACUTE CARE (Brown/McGinness)
Marco Hidalgo, MD (January)
Natalia Hannan, MD (February)
504.547-9031
504.582.0157
TMC/HEPATOBILIARY
(Buell/Killackey/Paramesh /Slakey)
Kelly Rennie, MD (January 1-6)
Marquinn Duke, MD (January 7-Feb)
504.584-4099
504.538-2621
TRAUMA (Duchesne/Meade)
Marquinn Duke, MD (January 1-6)
Marie Unruh, MD (January 7-Feb)
504.538-2621
504.538-2526
TMC/VA (Bellows)
Thomas Chaly (January)
Marco Hidalgo, MD (Feb-Mar)
504.538-2527
504.547-9031
John Guste, MD (January1-6)
Max Trahan, MD (Jan 7-Mar)
504.551-7374
504.584-6393
TMC/VEP
(Korndorffer/Kandil/Pigott/Dugal/Yeh/Steiner)
Pager
Ochsner 1:
1st Two weeks, Drs. Bolton and Conway: Surgical Oncology
2nd Two Weeks, Dr. Townsend Acute Care and General Surgery
Ochsner 2:
1st Two weeks, Dr. Corsetti: Surgical Oncology and Gen Surgery
2nd Two weeks, Drs. Richardson and Wooldridge: Laparoscopic and Bariatric Surg.
Ochsner 3:
1st Two weeks, Dr. Townsend: Acute Care and General Surgery
2nd two weeks, Drs. Bolton and Conway: Surgical Oncology
Ochsner 4:
1st Two weeks, Drs. Richardson and Wooldridge: Laparoscopic and Bariatric Surg.
2nd Two weeks, Dr. Corsetti: Surgical Oncology and General Surgery
Ochsner Office Contact: Helen Roussel, Administrative Assistant, Departments of Pediatric, Acute Care,
Oncologic, Bariatric, and General Surgery,l Ochsner Medical Center; e-mail: [email protected]; Phone:
504-842-3907; Fax: 504-842-5191; ext: 23907 or 20535
OLOL 2 /The Surgeons Group of Baton Rouge
Dr. John Whitaker
[email protected]
OLOL 3/Surgical Associates (not BRG)
Dr. Hirsch
[email protected]
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SURGERY CLERKSHIP
COURSE DIRECTOR:
Peter C. Meade, M.D. (988-2305 Room 8524)
[email protected]
PROGRAM COORDINATOR:
Stephanie Reed (988-3909 Room 8558)
Fax 988-1882
[email protected]
REQUIRED READING:
Essentials of General Surgery (Third Edition) by Peter F. Lawrence
SUGGESTED READING MATERIAL:
Sabiston Textbook of Surgery, 17th edition, (ed.) (Basic Science)
Current Surgical Therapy 8th ed (Cameron, ed-in chief) Chapters on
Pneumothorax, hemothorax, carotid enderectomy, and section on Preoperative and Post-operative care.
Surgery: A compentency-Based Companion by Barry D. Mann
(available in the bookstore.)
NOTE: It is not expected for you to read the entire book for any of the suggested reading. It takes the residents about one
year to finish one book. You should read the sections in the books that are pertinent to the patients you are seeing and the
operations which you are attending. When you have time, if you have not covered hernia, gallbladder, bowel obstruction,
acute abdomen, colon and breast cancer, (and any other topics you all can think of), read those chapters as well.
“The Virtual Patient” Self-directed Study Guide in Surgery (2007) Copyright from the University of Texas Southwestern
Medical Center at Dallas can be used as a study guide. Link : http://tmedweb.tulane.edu/portal/student-guide/item/surgery
Some links that you may find helpful are listed below:
Students with disabilities: http://erc.tulane.edu/disability/
Academic dishonesty link: http://www.som.tulane.edu/student/honorcode/new.htm
SOM Phase I & II Objectives:
http://tulane.edu/som/ome/upload/Tulane_SOM_Learning_Objectives_Phase_1_-_2.pdf
RESOURCES:
Several new learning resources have been added to the educational armamentarium of the clerkship.
They include:
1. Procedures Consult – The web based learning process provides considerable information, editorial, videos of specific
operational procedures. Weekly assignments are made and students are expected to complete them and take the brief
examination. Completion of the assignments will be monitored. (Instructions for login attached at end of document;
use your Tulane email address and the password is hello1. Please login in prior to the start of rotation and notify
Stephanie Reed if unable to login in order to address issues of problems before the assignments are due.
Assignments
T3s#5- #1
T3s#5- #2
T3s#5- #3
T3s#5- #4
T3s#5- #5
T3s#5- #6
T3s#5- #7
Assigned Date
01/04/12
01/11/12
01/18/12
01/26/12
02/01/12
02/08/12
02/15/12
Due by/on
01/11/12
01/18/12
01/25/12
02/01/12
02/08/12
02/15/12
02/22/12
In addition to the assignments, students are encouraged to review the material in Procedures Consult which is
relevant to their patients.
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2. Resident Lectures – On each service, the residents have been assigned lectures to present to the students on their
service. The same topics will be presented each week on all services. The lectures and topics are all among the 27
topics listed below. The following topics are to be covered:
Week 1
Colon Cancer
Week 2
Femoral Artery Occlusions
Week 3
Hemorrhoids Fistula-in-Ano
Week 4
Breast Cancer
Week 5
Obstructive Jaundice
Week 6
Appendicitis
Week 7
Melanoma
Week 8
Carotid Disease
Grand Rounds – Grand Round lectures will be recorded using Tegrity. The recording is available on the Surgery minisection on TMedWeb, link http://tmedweb.tulane.edu/portal/t3t4 - At TMedWeb website: choose a Clerkship Article to
View; Select the Surgery tab; Click Grand Rounds Recording.
OBJECTIVES OF THE ROTATION: Surgery is a discipline that provides care to patients in the outpatient areas,
hospital ward, and operating room. The clerkship is designed to teach students the role of surgical care in the overall
management of patients. Specifically, the students are expected to learn the work-up and evaluation of surgical patients. The
indications and contraindications for expected results, risks and complications of specific operations. While the operating
room is one site of leaning, it is NOT the only site. Students are expected to be able to scrub on a number of operations, but
involvement in a large number of operations is NOT the goal of the rotation. Ideally, students will be able to follow patients
from presentation, work-up, treatment including operations and post-treatment/postoperative care. It is this continuum that is
the major goal of the clerkship.
Twenty-seven diseases have been selected as targets for your education. They are listed below:
ACUTE
Surgical Infections
Acute Pancreatitis
Hemorrhagic Shock
Cholecystitis
Nutrition
Abdominal Trauma
Appendicitis
Diverticulitis
Thoracic Trauma
GENERAL
Peripheral Vascular Disease
Peptic Ulcer Disease
Inguinal Hernia
Carotid Disease
Upper Gastrointestinal Bleeding
Postoperative Complications
Reflux Esophagitis
Fistula-in-Ano
Portal Hypertension
ONCOLOGY
Breast Cancer
Adrenal Mass
Thyroid Nodule
Obstructive Jaundice
Colon Cancer
Splenectomy for Disease
Intestinal Obstruction
Lung Cancer
Melanoma
The Department of Surgery expects you to study these diseases on the rounds, in the operating room if possible, in the
classroom, and at home using textbooks. The oral examination will focus on these 27 topics.
DESCRIPTION:
All students are to assemble for the Principles of Surgery portion of the clerkship. This series of
lectures is designed to provide you with:
1. A surgical perspective relative to fundamental topics in Medicine
2. Basic technical skills in knot-tying & suturing
A written examination (consisting solely of questions taken from the lecture material and lab day) will be administered upon
completion of this lecture series (Thursday, January 5, 2012 from 8-9 AM in room 6065). An oral examination will be
administered to each student shortly before the written examination. Upon completion of General Surgery Services, a
National Board of Clinical Sciences Examination will be administered. Your clinical duties will end at 7:00 p.m. on the
Wednesday (February 22, 2012) immediately prior to Friday’s final examination, (Friday, February 24, 2012 room
7062, 1430 Tulane Avenue Street 7:30 AM, room 7062). No additional time will be granted from clinical duties for
study preparation.
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FINAL GRADE:
Student Evaluations:
1st General Surgery
2nd General Surgery
25%*
25%*
Examinations:
National Board Surgery Examination
Oral Examination (General Surgery)
Knot Tying & Suturing
Principles of Surgery Examination
Case Summaries
25%*
10%
5%
5%
5%
TOTAL
100%
GRADING POLICY: To receive a grade of “pass”, a student must achieve acceptable standards on both the National Board
Examination (equivalent to a score in the 5th percentile), and on each of the student evaluations. These requirements are
marked with an asterisk above.
Should a student fail only the National Board Examination (and receive passing grades on each clinical rotation), a letter
grade of “C” (Condition) will be assigned. Given those circumstances, the student will be asked to undertake a period of
intense reviewing of the precepts in General Surgery – upon completion of the remainder of their academic year. A second
National Board Examination will be offered; should he/she fail this examination, that student will be required to repeat the
entire General Surgery clerkship prior to January of the graduating year.
A student who receives a failing grade on any of the faculty evaluation forms will be notified immediately, and the General
Surgery Medical Student Curriculum Committee will review their clerkship performance. Unless evidence is presented to the
contrary, the student will receive a grade of “F”, and be asked to repeat, and pass elements of the entire General Surgery
clerkship prior to January of the graduating year. You will have a mid block evaluation 2 weeks into your General Surgery
clerkship by your resident and faculty. If you do not receive this mid block evaluation, please discuss this with your
resident.
A distinctly superior performance by a medical student on this clerkship will be properly accorded a letter grade of “High
Pass” or “Honors. A candidate for “High Pass” must have established the following: In most, if not all areas, numerical
grades that consistently signify a quality performance. A candidate for “Honors” must have established the above criteria and
in addition, must receive at the national mean average or higher on the national board exam which is a 73.1. There is no
exception to the above.
Honors – 90 -100; High Pass – 87-89; Pass 80-86; Condition 65-79; Fail <65
In the student letter to the Dean’s Office, the course director will at minimum, summarize the written comments received by
the student on the rotation assessment forms. A statement as to the students’ performance on the National Board Clinical
Sciences Examination may be included in each letter.
STUDENT ASSESSMENT:
Evaluation Forms:
Each faculty and highest level resident will receive an evaluation form, designed to assess your
progress in mastering the fundamentals in surgery, and will contain their consensus of your progress.
Oral Examination:
You will be assigned a faculty member in the Department of Surgery who is responsible for
administering your oral examination (see table for your assignment on page 9). Oral exams are to be scheduled between,
Monday, February 13, 2012 (DO NOT WAIT UNTIL FEBRUARY 13th TO SCHEDULE) and must be completed by
Wednesday, February 22, 2011 (with the exception of the OLOL students on the rotation for the period of January 30, 2012
to February 22, 2012 must be completed after the shelf exam on Friday, February 24, 2012).
It is your responsibility to contact the office of the assigned staff member to mutually set aside ½ hour, during the final week
of the rotation, for this examination. The date and time of the exam are the choice of the examiner.
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Any student who fails the oral examination will be asked to retake the test until a minimally acceptable performance is
achieved (<67) and the grades will be averaged for a final grade.
Student
Faculty
Contact
Dr. James Brown
Maria Reynaud 988-7520
[email protected]
Maria Reynaud 988-7520
[email protected]
Mel’isa Martin 988-2317
[email protected]
Leslie Schwartzman 988-5111
[email protected]
Leslie Schwartzman 988-5111
[email protected]
Angela Stewart 988-7123
[email protected]
Debra Felix 988-5500
[email protected]
Stephanie Reed 988-3909 [email protected]
or [email protected]
[email protected]
Diana Lambert 988-0783
[email protected]
Diana Lambert 988-0783
[email protected]
Maria Reynaud 988-7520
[email protected]
Angela Stewart 988-7123
[email protected]
Debra Felix or Heide Dyer 988-5500
[email protected] or [email protected]
[email protected]
Maria Reynaud 988-7520
[email protected]
Stephanie Reed 988-3909
[email protected] or [email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Maria Reynaud 988-7520
[email protected]
Archer, Benjamin
Dr. James Brown
Barthelemy, Andre
Dr. Douglas Slakey
Chang, Olivia
Trauma Faculty
Chen, Thomas
Trauma Faculty
Denson, Aaron
Dr. James Korndorffer
Dooley, Erin
Plastic Faculty
Finkbeiner, Brandon
Dr. Clifton McGinness
Garstka, Meghan
German, David
Dr. Jennifer McGee
Transplant Faculty
Guice, Jordan
Transplant Faculty
Halstead, Michael
Dr. Charles Bellows
Hayes, Justin
Dr. James Korndorffer
Hodnette, Christopher
Plastic Faculty
Khan, Taimur
Moak, Joseph
Dr. B. Jaffe
Dr. Emad Kandil
Neeland, Marc
Dr. Steven Jones
Padway, Shelby
Swann, Forrest
Welsh, Leonard
Whiting, Curtis
Yonge, John
Dr. B. Jaffe
Dr. Jennifer McGee
Dr. B. Jaffe
Dr. B. Jaffe
Dr. Emad Kandil
Yuan, Jennifer
10
FRIDAY EDUCATION CONFERENCES:
Entire Rotation: DRESS APPROPRIATELY for conferences, SCRUBS ARE NOT APPROPRIATE! IF YOU
QUESTION WHAT IS APPROPRIATE, ASK YOU RESIDENT.
1. M & M: 7:00 AM-8:00 AM in room 6065 This conference will be attended by surgical faculty, residents and medical
students. This educational conference is designed to teach the pathophysiology and decision-making process
regarding complex and interesting surgical cases and surgical cases that result in a complication.
2. Department of Surgery Grand Rounds: 8:00 AM-9:00 AM in room 6065
Presentations at this conference will be by department faculty, invited lecturers and surgical residents as assigned by the
chairman. These presentations should last 30-40 minutes, with a period of questions and answers if one lecture is to be
given. On certain dates, two case presentations may be given, each lasting approximately 20 minutes. This format will
be used primarily for resident presentations. You will receive by e-mail prior to the Grand Rounds to inform you of the
topic.
3. Bullpen (See page 13-15): 9:00 AM-10:30 AM (time changes as noted) in Room 6001
4. Case Summary & Subspecialty Lectures: 10:30 AM to 12:30 PM (time changes as noted) in Room 6001
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Date
M&M
7 AM
Room
6065
Grand
Rounds
8 AM
Room
6065
0/13/12
01/20/12
01/27/12
02/03/12
02/10/12
02/17/12
Case Summary and SubSpecialty lectures/conferences
Room 6001
Faculty
8:00 AM w/Dr. Jaffe
9:00 AM Case Summary:
Dr. Jaffe
Yonge, John
Thyroid
ENT Chief Resident
Padway, Shelby
10:00 AM Otolaryngology
Dr. Johnson
German, David
9:00 AM w/Dr. Jaffe
10:30 AM Case Summary: Lung Ca Dr. Dugal
Guice, Jordan
Whiting, Curtis
Neeland, Marc
11:00 Orthopedic Surgery
Dr. Ollie Edmunds
10:00 AM w/Dr. Jaffe
9:00 AM Case Summary:
Dr. Korndorffer
Chen, Thomas
Reflux Esophagitis
Hayes, Justin
Hodnette, Christopher
11:00 AM Urology
Dr. Raju Thomas
9:00 AM w/Dr. Jaffe
10:30 Case Summary: Pancreatitis Dr. Jaffe
Darconte, Mary
Resident: Dr. Martin
Archer, Benjamin
11:30 AM Lecture:
Garstka, Meghan
Neonatal Obstruction
Halstead, Michael
9:00 AM w/Dr. Jaffe
10.:30 AM Case Summary:
Dr. Brown
Wash, Erin
Intestinal Obstruction
Chang, Olivia
11:30 Shelf Preparation
Dr. Jaffe
Denson, Aaron
Finkbeiner, Brandon
10:00 AM w/Dr. Jaffe
9:00 AM Case Summary:
Dr. Kandil
Dooley, Erin
Adrenal Incidentloma
Hartman, Katharine
Moak, Joseph
11: 30 AM Shelf Preparation
Dr. Jaffe
Swann, Forrest
9:00 AM w/Dr. Jaffe
10:30 AM Shelf Preparation
Dr. Jaffe
Barthelemy, Andre
Khan, Taimur
Welsh, Leonard
Yuan, Jennifer
Case Summary Conference: All students are invited to discuss their case scenarios.
Canceled
01/06/12
Bullpen
Students Presenting
Room 6001
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SURGICAL BULLPEN
Background: The Surgery Bullpen is an exercise for students to hone their case presentation skills as
well as learn pathophysiology and management of surgical diseases. The contemporary Bullpen is
based upon a tradition begun by Dr. Alton Ochsner nearly seventy years ago. Senior Tulane students
were assigned an unknown patient and were expected to determine the diagnosis and differential,
treatment plan and the pathophysiology following a brief history and physical examination without the
patient chart or other information. The exercise was modified and extended to the third year clerkship in
a way similar to the present Bullpen. The Tulane Surgical Bullpen gained national notoriety and was
described in an article in Time Magazine nearly fifty years ago.
The Rules: Four to Five students are assigned to present at Surgical Bullpen each Friday at 9:00 am in
Room 6001. Each presentation is approximately fifteen minutes. Students are assigned patients by Dr.
Jaffe and the student coordinator, Ms. Stephanie Reed, on the preceding Wednesday morning, and she
will contact you with the name and bed of the patient. The patients will be from Tulane University
Hospital and University. You should review the patient’s chart, do a history and physical examination
where appropriate and review pertinent laboratory and radiographic studies. Sometimes the patients are
too ill or incapacitated to give a history or to even be examined. Use your own judgment, but remain
sensitive to the patient’s situation, comfort and dignity. Frequently, all of your information must come
directly from the chart and not from the patient. If so, simply make that clear in your presentation.
Presentations should be made just as if you were in the hospital. Decorum requires you to wear your
white coat and for men to either wear ties or scrub suits and women accordingly. Make your
presentations concise and precise. If possible bring radiographs, arteriograms or other imaging studies
which add value to the presentation. University no longer permits the students to check out films. You
receive the film on a CD rom. If it is of value to present the film, a lap top will be made available in
Room 6001 for your presentation. Do not prepare Power Point, overheads, hand outs, or movies, but
you are free to use your notes and to draw anatomy, procedures and other diagrams on the black board
when indicated. You may prepare by textbook reading and review of articles. Since patients are
currently discharged very soon after uncomplicated operations, occasions do arise when the patient has
been discharged prior to your visit to them. If that occurs, you will simply present from the chart but
indicate this during your presentation.
Please do not use this conference for your lunch time. No food or drinks are allowed while this
Bullpen is taking place. Thank you.
13
CASE SUMMARY GRADE FORM

Organization
25%
Grade

Content
50%
Grade

Clarity, grammar & style
15%
Grade

References
10%
Grade

“Bonus Points”
Total Grade
14
JUNIOR SURGERY STUDENT CASE SUMMARY CONFERENCE
PURPOSE:
The purpose of the case summary conference is to provide an opportunity to improve clinical problem
solving, library research, oral presentation, and writing skills. This exercise will be done in the small group seminar format.
A series of case studies have been prepared. There will be a faculty facilitator at each conference. One or more students will
be chosen at each conference to present and defend the case summary each has prepared for the conference. All case
summaries must be given to Stephanie (room 8558, [email protected], or faxed to 988-1882) before the conference begins.
Case summaries submitted after the start of the conference will not be accepted for a grade.
BASIC INSTRUCTIONS:
1. During the course orientation, each student will receive the case histories on which each conference will be based.
2. You should review the case histories and prepare a one page written summary of your analysis of the problem posed by
the case, your understanding of the pathophysiology, and your plan for management of the case. Neatness counts.
Typewritten reports are preferred. If we can’t read it - we can’t grade it properly. (e.g. font of typewritten reports is too
small or penmanship is poor) Please make sure you limit your summary to one page, including references. Failure
to do so will result in deducted points.
3. You are expected to read, utilize, and accurately cite at least three references from the literature (not the internet
or a textbook) dealing with 3 different aspects of the topic, at least one and preferably two, from surgical journals.
You should know how to look up journal articles and how to document their citations accurately, something you
will have to do as part of your education, residency and career. Do not quote statements from the articles in the
text of your paper. That process dilutes your learning how to utilize information and write it for others to read. In
addition, avoid initials or other language shortcuts to learn to make the document readable.
4. Grades for each summary will be based on the following:
 Organization
25%
 Content
50%
 Clarity, Grammar & Style
15%
 References
10%
5. There will be an emphasis on complete and compassionate care plans which focus on the best interest of the patient. Cost
effective case will also be stressed.
GRADE:
Your grade will be derived from all six case summaries. The composite grade will count as 5% of your
clerkship grade.
15
Dr. Bernard Jaffe
Thyroid Mass
A 32-year-old man is seen with a 1.5-cm firm nodule in the left lobe of the thyroid gland. The remaining gland is normal to
examination. His only relevant past history is that he received radiation therapy for Hodgkin’s disease involving the
mediastinum.
1. What is the differential diagnosis?
2. How can you reach a definitive diagnosis in an efficient and cost-effective manner?
3. Which thyroid function studies would be useful?
4. Which radiologic studies would be needed prior to planning therapy?
5. If the diagnosis was follicular carcinoma, what are the options for operative therapy, and what would you do?
6. What postoperative complications are specific to this procedure?
7. What specialized follow up would be in order?
ADDITIONALLY, DR. JAFFE WOULD LIKE YOU TO HAND YOUR CASE SUMMARY INTO HIM AT THE TIME OF THE
LECTURE. YOUR CASE SUMMARY WILL NOT BE GRADED IF NOT HANDED INTO DR. JAFFE AT THE TIME OF THE
CASE SUMMARY (EXCEPT FOR OLOL STUDENTS WHO WILL CONTINUE TO E-MAIL TO ME)
16
Dr. James Brown
SMALL BOWEL OBSTRUCTION (SBO)
A 53 y/o female presents to the ER with the acute onset of abdominal pain, nausea, vomiting, and moderate abdominal distention for the
last 18 hours. The ER doctor has ordered some studies, suspects a SBO and consults you for further diagnosis and therapy.
1. While you are on your way to the ER to see the patient, what differential diagnoses would you be considering?
2. List three of the most pertinent questions you would ask about the present illness and why.
3. IF patient has SBO (complete-simple), list three most common physical findings that would be compatible with your diagnosis.
4. Why are the CBC and BMP important in this patient?
5. What radiographic studies would you want and why---in their order of complexity and expense?
6. Outline a plan of treatment based on your diagnosis of SBO, considering the classification of partial vs. complete and simple vs.
gangrenous.
17
Dr. Dugal
Lung Cancer
72 y/o WF w/ recent onset of shortness of breath. CXR revealed RLL pneumonia. W/U included bronchoscopy which
revealed an endobronchial lesion in the bronchus intermedius. Biopsy was taken.
1)
What is likely diagnosis?
2)
What other history would be pertinent?
3)
What further W/U is needed?
4)
What surgical intervention is needed or not needed?
5)
What complications and outcomes would be expected if surgery is performed?
18
Dr. James Korndorffer
Reflux Esophagitis
1. What are the typical symptoms of GERD? Atypical Symptoms?
2. What workup is needed to evaluate for GERD?
3. Assuming the diagnosis is uncomplicated GERD, what are the appropriate management options? What would you tell
your patient about those options?
4. What operative interventions are performed for GERD? Why is one selected over the other?
5. What are the success rates for operative intervention?
6. If Barrett's esophagitis is documented on workup, how does it alter your management?
19
Dr. Bernard Jaffe
PANCREATITIS
A 45 year old obese female with a history of multiple episodes of identical right upper quadrant pain is admitted with
epigastric pain and tenderness. Her lipase is 750 and her amaylase is 3,200.
a.) What is the likely diagnosis?
b.) What are some other possible causes of her disease?
c.) How should you determine if she has a common duct stone? Does it change the treatment if there is one?
d.) What are Ranson’s criteria at 48 hours for severe disease?
e.) What are the common complications of this disease and what should you do to try to prevent them?
f.) What are the indications (if any) for antibiotics?
g.) What are the indications for cholecystectomy, and when should it be performed?
h.) If she develops a pseudocyst, what options are there for drainage? Which would you choose and why? When should
it be performed?
Dr. Jaffe expects you, the student, to read, utilize, and accurately cite at least three references from the literature (not
the internet or a textbook) dealing with 3 different aspects of the topic, at least one and preferably two, from surgical
journals. He wants you to know how to look up journal articles and how to document their citations accurately,
something you will have to do as part of your education, residency and career. In addition, Dr. Jaffe does not want
you to quote statements from the articles in the text of your paper. That process dilutes your learning how to utilize
information and write it for others to read. In addition, he requests that you avoid initials or other language shortcuts
to learn to make the document readable.
ADDITIONALLY, DR. JAFFE WOULD LIKE YOU TO HAND YOUR CASE SUMMARIY INTO HIM AT THE TIME OF THE
LECTURE. YOUR CASE SUMMARY WILL NOT BE GRADED IF NOT HANDED INTO DR. JAFFE AT THE TIME OF THE
CASE SUMMARY (EXCEPT FOR OLOL STUDENTS WHO CONTINUE TO E-MAIL TO ME)
20
Dr. Emad Kandil
Adrenal Incidentloma
42 year old previously healthy man is evaluated for right hypochondriac pain. W/U included abdominal US. There
was no evidence of cholecystitis, however, a 4 cm mass in the right adrenal gland was found.
Issues:
a.) What is the differential diagnosis of this mass.
b.) What tests would you want to order to narrow your differential diagnosis?
c.) Would you biopsy the lesion if you were to decide to follow this lesion?
d.) Assuming all tests come back negative, at what size would you operate on an incidentaloma?
e) Assuming the patient has an aldosteronoma, how will you differentiate hyperplasia from an adenoma? Do you
need to do selective venous sampling?
21
GENERAL SURGERY
DESCRIPTION:
The General Surgery rotation is primarily an inpatient-based experience designed to familiarize the
student with acute and elective surgical decision making processes (see Goals & Objectives) However, to the extent that
much of the preoperative and postoperative management is now carried out in the outpatient setting, students will as well be
expected to participate in this phase of care.
A team of surgery house officers and at least one attending surgeon-preceptor will staff each General Surgery service, on
which medical students will rotate. These personnel will provide ample opportunities for “on the job” experience relative to
the discipline of Medicine in general and surgery in particular.
In accordance with the ACGME requirements, you may not be in the hospital more than 80 hours per week and you are
required to have at least one day off each week.
You will have a mandatory presentation weekly. This presentation will be a 15 minute oral presentation, backed-up by a 1
page paper, given to the faculty or resident of your service while you are on your general surgery month. Your chief resident
will discuss what, where and when in regards to this weekly presentation. If your resident does not, please let me know.
Again this should be weekly while you are on your general month.
IN-HOUSE CALL:
All students will be expected and required to take in-house call on your service’s team. If there are
two students on the service, you may alternate call but there should be a student with the intern on
call at all times. The students’ call room is at Deming.
HOSPITAL SITES:
University Trauma (Dr. Duchesne/Leslie Schwartzmann – 988-5111) - In-house call will be expected on those days on
which the Tulane Faculty has primary call (approximately every 4th night). You are to maintain the same on-call hours as
your house officer. Please note that in keeping with the ACGME 80-hour work week, when you do take In-house overnight
call, you may only work an additional 6 hours after that call ends; but note, you will be expected to make rounds after inhouse call nights to sign patients off to the next service.
The Call Rooms are located on the 1st floor next to the resident nourishment room. When entering the call room pod, you
turn left then make 2 rights, and it’s the 3rd door on the right. The first door has a sign that says "Surgery Senior
Resident aka Boss". The 2nd door is the intern's room, and the 3rd door is the student room.
The keycard is stored in the TICU on the whiteboard tray, though the call room's door is usually taped open
anyway.
The notes on your patients will be expected to be complete by 6:30 AM.
Please contact your resident the evening before; as they might not be able to return your call the minute you are ready to
begin that service.
Tulane ID’s are not compatible with the access control system at University. Tulane students who are assigned to
MCL/University need to go to the medical staff office. The medical staff office will make arrangements for you to be issued a
MCL/University affiliate badge which will grant you access to the approved areas. The medical staff office is Room 313 in
the Butterworth Building at 1541 Tulane Ave. For questions, send mail to:[email protected].
22
You are scheduled for a medical student rotation at Ochsner Medical Center, New Orleans. Each
student will be assigned to one of the several surgical services for a four week rotation. Please read important information
below:
Ochsner Hospital:
Registration
On your first day please register at 8:30 am with the Department of Medical Education, Brent House, 6th floor, Room 635 at
8:30 am. Audra Detillier (504-842-3267).
Computer ID/Password
Issued at registration
Then report to Helen Roussel (504-842-3907), Administrative Assistant, General Surgery Department on the 5th floor,
Clinic Tower, (take the C elevators) check in at the front desk for a brief informational meeting. Ms. Roussel will bring you
to Safety and Security and then to your scrub class.
ID Card
All students are required to have an Ochsner ID card while rotating at Ochsner. Ochsner's Safety and Security department
will issue ID cards. There is a $10.00 refundable cash deposit for an ID card. You must return the ID card at the end of your
rotation.
Parking
Parking is located in our Coolidge Parking lot located behind the Ochsner Pediatrics and Breast Center buildings across the
street from the hospital.
EXPECTATIONS: The expectations for students on their general surgery rotation are to see patients in clinic, scrub in the
operating room, and follow patients in the hospital. Students will be directed in these activities by the residents and staff on
their services. Students are expected to read on surgical problems they are involved with or are likely to encounter. In
addition, students are to go to all lectures for general surgery residents. There is no call but students will stay through the end
of the work day and be involved with rounds on Saturday. Students will not come in to work on Sundays. Students will be
relieved of any work at Ochsner to go to anything required at Tulane.
During each of your rotations, you will be given ample opportunity to work with your surgery team in the inpatient and
outpatient environments. You are expected to become an integral part of the service to which you are assigned. All student
rounds must be completed prior to making rounds with the residents. This will necessitate early arrival at the hospital so that
all patients can be evaluated prior to making rounds with the residents and staff. There will be no in-house call, but you
should remain with your team until the clinical and educational responsibilities have been completed for the day. In order to
be sure that students have the opportunity to monitor surgical patients’ progress, rounds will be required to be made every
day, including Saturdays. Students will be given Sunday off to comply with the 24-hour off rule.
Students are REQUIRED to attend all Friday educational conferences (see pages 12-13).
Dr. Corsetti will complete an exit interview prior to the end of the rotation. The purpose of this is to discuss the student’s
evaluation of their performance during this rotation, and to allow the student the opportunity to discuss the quality of their
educational experience at Ochsner. Dr. Corsetti may, depending on the demands on his time, not be able to complete an exit
interview with each student individually (this will continue to be monitored).
23
Tulane Medical Center/Lakeside/Childrens:
TMC Acute Care:
Drs. McGinnis (301-0270; [email protected] ) and Brown (583-6459 [email protected])
TMC VA:
Dr. Charles (Chip) Bellows [email protected] (988-2307)
TMC Vascular/Peds/Elective: Drs. Pigott/Dugal/Yeh/Steiner/Kandil/Korndorffer
Dr. Pigott 988-2281 [email protected]; Dr. Dugal 988-5492 [email protected] Dr. Yeh 9888677 [email protected] ;
Dr. Steiner 988-3994 [email protected]; Dr. Korndorffer 988-7123 [email protected];
and Dr. Kandil 988-7520 [email protected])
Lakeside General:
Dr. Stephen Jones (988-2305 [email protected])
Melanie Jeansonne, Clinic Nurse, 988-8168; [email protected]
Transplant:
Dr. Joe Buell is the Interim Director of Abdominal Transplant (988-7867
[email protected] ) but you will additionally work with Drs. Mary Killackey, Anil
Paramesh , Bob Saggi (988-0783) Douglas Slakey (988-2317).
TRANSPLANT SURGERY CURRICULUM—
Meet the 2nd and 4th Thursday of each month from 7:45-8:30 (before clinic) in the clinic side of the
hospital- Rm # TBD. The curriculum will be based on the modules set forth by the American
Society of Transplant Surgeons.
Students rotating on TMC Hepatobiliary, meeting with all the residents and students at the beginning of the rotation to
discuss expectations. Student notes will NOT be included in the patient’s chart. Therefore it will be mandatory that you
write 3 H & P’s and 6 progress notes, give to the faculty you are working with and those will be graded and placed in your
file. Students pick up new patients and present them on rounds. They also have to continue to present their patients daily
while they are inpatient, which is used as their H&P and progress notes used for evaluation. Additionally, there is no inhouse call for students on this TMC Hepatobiliary Service. There are clinics and other conferences that you will be expected
to attend as are the residents. Transplant office has a bibliography of core reading materials for you. Students should look to
the senior resident on the service for direction.
24
Childrens Peds:
Dr. Rodney Steiner (988-3994 [email protected] )
The students assigned to this service will assist in the care of those patients under the care of the General Surgery Service.
House officers will provide resident coverage for this service. Your duties are to include, but are not limited to:
1.
2.
3.
4.
5.
6.
Provide daily inpatient care for the patients to whom you are assigned.
Perform histories and physical examinations.
Participate in the operations being performed on your patients.
Work with attending physicians in their outpatient clinics (3rd floor of professional office building)
Attend all Friday morning Educational conferences.
Be available for home call up to every third night and every other weekend.
EXPECTATION: The expectations for students on their general surgery rotation are to see patients in clinic, scrub in
the operating room, and follow patients in the hospital. Students will be directed in these activities by the residents and
staff on their services. Students are expected to read on surgical problems they are involved with or are likely to
encounter. In addition, students are to go to all lectures for general surgery residents. There is no call but students will
stay through the end of the work day and be involved with rounds on Saturday.
Expectations:
Make rounds with the resident on the service every AM. Examine the patients, review the labs, come to decisions,
and make recommendations consistent with resident and staff. Naturally, implementations of recommendations
depend on resident and staff.
Do complete history and physicals on new patients admitted to the service and turn them in to the attending for
review.
See consults to the service and do history and physicals, review labs, make recommendations consistent with
resident and staff recommendations.
Make rounds with staff daily and present patients to staff in a manner consistent with working rounds. Much
teaching will be done on these rounds. Therefore, students are expected to have read about the diseases present in
their patients.
Students are expected to attend surgery on all of their patients. There must be a good reason to be absent from the
surgical procedure on their patients.
Students are expected to attend clinics at Lakeside and do complete histories and physicals on the new consults
and referrals and discuss diagnoses and recommendations with the staff attending.
Students are expected to take call at night for emergency admits and emergency surgery.
Students are expected to learn basic surgical procedures well enough to assist in surgery.
Students are encouraged to attend surgical procedures done on patients other than their own if it does not conflict
with primary responsibilities.
Students are encouraged to make week-end rounds on their hospitalized patients.
25
OLOL
We have 3 different rotations based out of Our Lady of the Lake in Baton Rouge; listed below in red. Each rotation will
rotate at different hospital sites and each site has its own packet of paperwork (as depicted below). Please see Janice Lucas
in Dr. Krane’s office, when the schedule comes out to complete these packets. The earlier the packets are completed and
returned, the more assurance you will have that your experience on the rotation will run smoothly.
Rotation Name
OLOL BR General/HIPAA Compliant
Lake Surgery Center Women’s
Yes
No/No
No
Yes
Dr. Whitaker
(OLOL 2)
Yes
Yes/Yes
Yes
Yes
Dr. Hirsch/Gordon
(OLOL 3)
The Surgeons Group of Baton Rouge
Dr. Mark Hausmann, MD, FACS – General Surgery, Bariatric Surgery
John Whitaker, MD [email protected]
Karl LeBlanc, MD [email protected]
Keith Rhynes, MD [email protected]
Kenny Kleinpeter, MD [email protected]
Brent Allain, MD [email protected]
7777 Hennessy Blvd., Suite 612
Baton Rouge, LA 70808
Office #: (225) 769-5656;
CELL: (225) 229-9094 FAX #: (225)766-6996 e-mail: [email protected]
Dr. Alec Hirsch – General Surgery, Surgical Associates.
[email protected]; office #: (225) 769-6400 fax: 225.769-6404
Contacts:
Housing, ID badges, computer access, etc:
Baton Rouge General Medical Center
Lisa Loustalot, Coordinator, Graduate Medical Education
Our Lady of the Lake Regional Medical Center
Plaza 2 Suite 6004
Phone 225-765-7730 Direct Line: 225-765-8769
[email protected] Fax 225-765-3497
(BRG)
Roberta Cartaginese, LEAD Senior Program Coordinator
Tulane University School of Medicine 225-387-773; 225-387-7872 (Fax) : [email protected] or
[email protected]
Connie Rome, GME Manager; [email protected]
Sandra Wiley, Senior Coordinator; [email protected]
(225) 387-7736 or (225) 387-7707 Fax (225) 387-7872
Floyd J. Roberts, Jr., M.D., FACP, FCCP, Chief Medical Officer, Medical Director of Graduate Medical Education & DIO of
Baton Rouge General Medical Center (225) 387-7121. Jayne B. Bacot, RN @ Lake Surgical @ 225-765-3133.
John Clifford, MD, FACS, Medical Director Graduate Medical Education and DIO of OLOLRMC @ 225-765-1955.
26
Department of Surgery
Hutchinson Building, 8th Floor
SL 22
(504) 988-3909
(504) 988-1882 fax
DESCRIPTION:
The General Surgery rotation is primarily an inpatient-based experience designed to familiarize the
student with acute and elective surgical decision making processes (see Goals & Objectives) However, to the extent that
much of the preoperative and postoperative management is now carried out in the outpatient setting, students will as well be
expected to participate in this phase of care.
A team of surgery house officers and at least one attending surgeon-preceptor will staff each General Surgery service, on
which medical students will rotate. These personnel will provide ample opportunities for “on the job” experience relative to
the discipline of Medicine in general and surgery in particular.
During the course of the General Surgery rotation, you are to keep a concise log of all patients for whom you were given
primarily responsibility. Specific data to be recorded are: primary diagnosis, whether management occurred on an inpatient
or outpatient basis, operation (if any), and complications.
HOSPITAL SITES:
University, Ochsner, TMC, OLOL and Lakeside.
GOALS
Patient Care:
1. Insert Nasogastric tube.
2. Insert Foley Catheter.
3. Be able to perform as a second assistant in the operating room.
4. Be able to function as a first assistant for minor or bedside procedures.
5. Demonstrate sterile technique.
6. Demonstrate patient prep in operating room.
7. Perform wound or incision closure.
8. Describe the steps and indications for central line insertion.
Medical Knowledge:
1. Perform a complete history and physical exam.
2. Write appropriate patient admission orders for a variety of surgical conditions including but not limited to: trauma,
GI bleeding, vascular conditions, and acute abdomen.
3. Write appropriate post-operative orders for both out-patient and emergency surgery patients.
4. Assess and discuss management of post-operative fever.
5. Explain and interpret chest x-rays.
6. Discuss patient CT scans.
7. Discuss diagnosis and management of:
a. Surgical Infections
b. Acute Pancreatitis
c. Hemorrhagic Shock
d. Cholecystitis
e. Nutrition
f. Abdominal Trauma
g. Appendicitis
h. Diverticulitis
i. Thoracic Trauma
j. Peripheral Vascular Disease
k. Peptic Ulcer Disease
l. Inguinal Hernia
27
8.
9.
10.
11.
12.
13.
14.
15.
m. Carotid Disease
n. Upper Gastrointestinal Bleeding
o. Postoperative Complications
p. Reflux Esophagitis
q. Fistula-in-Ano
r. Portal Hypertension
s. Breast Cancer
t. Adrenal Mass
u. Thyroid Nodule
v. Obstructive Jaundice
w. Colon Cancer
x. Splenectomy for Disease
y. Intestinal Obstruction
z. Lung Cancer
aa. Melanoma
Interpret arterial blood gases.
Understand and verbalize indications for mechanical ventilation.
Discuss the differences and uses for various forms of mechanical ventilation.
Appraise patient for post-operative complications: infections, anastomotic leak, hernia, bleeding, DVT, heart attack,
hyperglycemia.
Discuss management and give examples of post-operative pain control.
Recognize symptoms, causes, and treatments of common electrolyte derangements in surgical patients:
a. Hyponatremia / Hypernatremia
b. Hypokalemia / Hyperkalemia
c. Hypocalemia
d. Hypomagnesemia
Demonstrate and discuss management of anemia.
Calculate daily caloric needs of different types of patients. Calculate and write TPN orders for a variety of patient
conditions.
Practice Based Learning and Improvement:
1. Evaluate patient care through personal assessment and feedback from residents and staff.
2. Develop personal process of acquiring and appraising scientific knowledge.
Interpersonal and Communication Skills:
1. Discuss patient condition and assessment with resident team.
2. Present patient to staff during rounds in clear concise manner, including exam, assessment of condition, and plan of
patient care.
3. Document steps in patient care.
4. Participate in development of patient care plan.
Professionalism:
1. Perform patient care in an ethical manner.
2. Attend conferences, clinics, and rounds on time.
3. Display commitment to patient care and educational process.
4. Respect patient culture, privacy, and disease process.
System Based Practice:
1. Define cost-effective patient care.
2. Understand the basic costs and risk-benefit of common lab tests, radiology exams, and operative interventions.
28
POST-OPERATIVE ORDERS
1.
Location of admission (recovery room, one day surgery, ICU, etc.)
2.
Status post (surgical procedure)
3.
Admitting physician
4.
Condition
5.
Vital signs (per recovery room protocol, then on ward, ICU, etc.)
6.
Diet
7.
Activity (up with assistance, bathroon privileges, etc.)
8.
Allergies
9.
Intravenous fluids
10.
Medications
11.
Nursing care orders (dressing care, wound care, assistant with ambulation, etc.)
12.
Care of drains, lines
13.
Intake and output; record patient weight daily
14.
Special nursing care orders
15.
Monitoring device instructions
16.
Miscellaneous (anything else necessary for good patient care, such as notifying the physician if the patient is unable
to void post-operatively, etc.)
17.
Laboratory tests
18.
Roentgenographic studies
19.
EKG
29
SURGERY THIRD YEAR MEDICAL STUDENT
MID-BLOCK EVALUATION
TWO WEEKS INTO EACH OF YOUR GENERAL SURGERY SERVICE, I WILL SEND OUT ELECTRONICALLY YOUR MID
BLOCKEVALUATION. BUT IT IS APPROPRIATE, AT THE APPROPRIATE DOWN TIME, TO ASK YOU’RE RESIDENT TO
COMPLETE THIS EVALUATION, REVIEW WITH YOU AND RETURN TO MY OFFICE FOR YOUR FILE.
PLEASE IF YOU DO NOT GET YOUR MIDBLOCK EVALUATION INTO YOUR THIRD WEEK OF YOUR GENERAL
MONTH, CONTACT STEPHANIE REED IMMEDIATELY AND DR. MEADE WILL CONTACT YOUR TEAM AND
REVIEW YOUR MID BLOCK PERFORMANCE WITH YOU. THANK YOU.
Date of Evaluation: _______, 2011
Evaluator: Dr.
Student Name:
Block #___2011-2012
Surgery Service:
Faculty evaluation summary: _____________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Resident evaluation summary: _____________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Surgery (common procedure log) review: ____________________________________
_____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Professionalism: ________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Student Response: _______________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Faculty signature: _______________________________________________________
Student signature: _______________________________________________________
Program Director’s Response: _____________________________________________
______________________________________________________________________
Program Director’s Signature: _____________________________________________
FAX: Stephanie Reed at 504-988-1882
30
Student Evaluation Form
Attachment 4
Instructions: Rate the student’s performance using the criteria listed below. Please provide written comments as well, as they may be
used to compute an overall grade.
Professionalism
No
Opportunity
to Observe
Frequently irresponsible,
unreliable, or late.
Appearance fails to
reflect a professional
image. Discourteous and
resists feedback.
Insufficiently motivated
to acquire knowledge.
Shows little improvement
over the clerkship.
Shows little initiative and
refuses leadership roles.
Unwilling to work as part
of a team.
0
1
2
Below average
attendance or
reliability. Appearance
does not typically
reflect a professional
image. Does not
readily acknowledge
mistakes/ tends to
resist suggestions for
improvement. Below
average initiative and
avoids leadership
roles. Below average
ability to work as a
team player.
3
4
Usually responsible and
can be counted on to
follow through on tasks.
Dresses appropriately for
the work environment.
Generally respectful of
the feelings of others.
Recognizes mistakes and
accepts responsibility for
actions. Exhibits initiative
at times and accepts
leadership role when
asked. Usually able to
handle stress and work as
part of a team.
5
6
Good attendance and
reliability. Sincere, honest,
represents self and others
accurately. Well-groomed
and dressed appropriately
for the work environment.
Acknowledges mistakes
and accepts responsibility
for actions. Sometimes
seeks leadership. Adapts
well to different situations.
Works effectively as part of
a team.
Always self-motivated,
punctual, and reliable.
Maintains professional
appearance. Honest,
trustworthy, and
courteous. Actively
seeks feedback and
works diligently to
correct deficiencies.
Eagerly assumes extra
responsibilities.
Excellent leader and
team player.
7
9
8
10
Patient Care
No
Opportunity
to Observe
History /physical exam are
incomplete with major
omissions noted. Does
not synthesize or use
knowledge in clinical
situations, and decisionmaking adversely affects
the patient. Does not
attend to patient comfort
or consistently contributes
to patient discomfort.
Displays minimal cultural
understanding and
sensitivity.
History/ physical
exam are sometimes
incomplete and fail
to note major
findings. Frequently
has difficulty
prioritizing clinical
management issues.
Demonstrates little
attention to patient
comfort and below
average cultural
understanding and
sensitivity.
History/physical exam
are usually complete,
accurate, and organized.
Represents average
knowledge base
pertinent to disease
process and patient
situation.
Demonstrates concern
for maintaining patient
comfort and displays
cultural understanding
and sensitivity.
History/physical exam
are thorough, clear, and
well-organized.
Represents above
average knowledge base
pertinent to disease
process and patient
situation. Demonstrates
high regard for patient
comfort and displays
above average cultural
understanding and
sensitivity.
0
1
3
5
7
2
4
6
Always performs a
complete, accurate, and
efficient assessment.
Consistently
demonstrates a solid
grasp and understanding
of complex issues as they
relate to patient
situations.
Demonstrates high
regard for patient
comfort and displays a
high level of cultural
understanding and
sensitivity.
9
10
8
Medical Knowledge
No
Opportunity
to Observe
Reflects failure to
read even standard
textbooks.
Knowledge is
limited, fragmented,
or poorly applied.
Needs significant
remediation.
Reflects cursory
review of standard
textbooks. Below
average knowledge
base and
application to
clinical problems.
0
1
3
2
4
Interpersonal & Communication Skills
31
Reflects review of standard
textbooks. Usually
demonstrates general
understanding of
pathophysiology, diagnosis,
and management. Can
generally integrate knowledge
to answer patient-driven
questions.
5
6
Reflects review of
standard textbooks
sometimes
supplemented by
current literature.
Above average
knowledge, well
applied.
Reflects in-depth review of
standard textbooks and
current literature. Able to
integrate basic knowledge
into the clinical situation.
Level of knowledge is far
superior to peers.
7
9
8
10
No
Opportunity
to Observe
0
Oral presentations
are consistently illprepared and
include major
omissions of
relevant data.
Rarely
communicates
effectively. Fails to
treat others with
respect. Focuses on
self at the expense
of others. Poor
rapport with team
and other
professional staff.
1
2
Oral presentations are
below average and do
not follow standard
format. Sometimes
communicates
effectively. Often fails
to treat others with
respect. Lacks focus on
the needs of others and
has difficulty
communicating
empathy. Occasional
difficulty with team and
professional staff.
Oral presentations are
thorough and efficient
but may contain
extraneous or irrelevant
information.
Communicates
effectively and usually
treats others with
respect. Focuses on the
needs of others but has
some difficulty
communicating empathy.
Good rapport with team
and other professional
staff.
Oral presentations are
accurate, wellorganized, and concise.
Communicates
effectively even in
difficult or new
situations. Treats
others with respect.
Focuses on the needs
of others and
communicates
empathy. Very good
rapport with team and
other professional
staff.
Oral presentations are
consistently accurate, wellorganized, and concise.
Consistently communicates
effectively, even in difficult or
new situations. Consistently
treats others with the utmost
respect. Consistently focuses
on the needs of others and
communicates empathy
effectively. Demonstrates
excellent rapport with team
and other professional staff.
3
5
7
9
4
6
8
10
Practice-Based Learning & Improvement
No
Opportunity
to Observe
Poor intellectual
curiosity. Does not
seek new information
and appears
uninterested in
learning. Consistently
resistant and
defensive to feedback.
0
1
2
Below average
intellectual curiosity.
Rarely seeks new
information and
resists learning with
others. Generally
resistant or defensive
to feedback.
3
4
Average intellectual
curiosity. Puts forth
effort to enhance
understanding and
development. Seeks
new information and
learns from others.
Responds well to
feedback.
5
6
Above average
intellectual curiosity.
Seeks new information
and strives to enhance
understanding and
development. Accepts
feedback willingly and
uses it to improve.
7
8
Exceptional intellectual
curiosity. Always seeking
more information and asking
insightful questions.
Analyzes medical literature
and incorporates it into
patient plan. Consistently
seeks and uses feedback to
improve.
9
10
Systems-Based Practice
No Opportunity
to Observe
Unable to formulate
cost-conscious
treatment plan. Fails to
demonstrate
understanding of the
psychosocial and
healthcare needs of
patients. Fails to
engage patient and
family in care plan.
Fails to coordinate
patient care with other
health care
professionals.
Does not typically
consider cost when
reviewing treatment
options. Below average
understanding of the
psychosocial and
healthcare needs of
patients. Generally does
not engage patient and
family in care plan and
does not usually
coordinate care with
other health care
professionals.
Considers costconscious treatment
options with assistance.
Average understanding
of the psychosocial and
healthcare needs of
patients. Engages
patient and family
when prompted, and is
generally able to
coordinate patient care
with other health care
professionals.
0
1
3
5
2
4
6
Usually considers cost
in planning. Above
average
understanding of the
psychosocial and
healthcare needs of
patients. Easily
answers patient and
family questions about
care and is able to
work with other
healthcare
professionals in
coordinating patient
care.
7
8
Consistently demonstrates
the ability to formulate a
treatment plan with
appreciation for cost.
Exceptional understanding
of the psychosocial and
healthcare needs of
patients. Volunteers
appropriate information to
patient and family.
Consistently and effectively
coordinates patient care
with other health care
professionals.
9
10
RIME – How would you rank this student using the RIME framework?
OBSERVER: Present, but contributes minimally to patient care.
REPORTER: Reliably, respectfully, and honestly gathers information from patients. Communicates with faculty. Gets the basic work done. Can answer
the “what” questions.
INTERPRETER: Shows selectivity, prioritization, and implies analysis. Actively involved in thinking through patient problems, and of acquiring
knowledge to offer a reasonable differential diagnosis. Can answer the “why” questions.
MANAGER: Clinical planning fulfills a promise of working with patients on diagnostic and therapeutic decisions and a promise of developing expertise
to do so. Consistently answers “how” to resolve problems. This is the level of a competent intern.
EDUCATOR: Personal planning and reflection fulfill a commitment to deeper expertise for self and colleagues and patients. Is committed to selfcorrection and self-improvement. This is resident level and few students will meet these criteria.
32
Observer
1
Reporter
2
3
Interpreter
4
5
Manager
6
7
Educator
8
9
10
Overall Performance/Competence: How would you rank this student compared to all students you have trained?
Bottom 10% of students I
have trained
1
2
Bottom 33% of students I
have trained
3
4
Middle 33% of students I
have trained
5
6
Please enter an overall numerical grade (Question 9 of 10 – Mandatory)
Honors – 90 -100; High Pass – 87-89; Pass 80-86; Condition 65-79; Fail <65
33
Top 33% of students I
have trained
7
8
Top 10% of students I
have trained
9
10
TABLE OF CONTENTS FOR ORAL EXAM
You will be questioned on 1 topic from each of the 3 categories below (therefore 3 total questions). All test questions can be found
in the Sabiston & Schwartz textbook.
ACUTE
1.
2.
3.
4.
5.
6.
7.
8.
9.
Surgical Infections
Acute Pancreatitis
Hemorrhagic Shock
Cholecystitis
Nutrition
Abdominal Trauma
Appendicitis
Diverticulitis
Thoracic Trauma
GENERAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
Peripheral Vascular Disease (Fem Pop)
Peptic Ulcer Disease
Inguinal Hernia
Carotid Disease
Upper Gastrointestinal Bleeding
Postoperative Complications
Reflux Esophagitis
Fistula-in-Ano
Portal Hypertension
ONCOLOGY
1.
2.
3.
4.
5.
6.
7.
8.
9.
Breast Cancer
Adrenal Mass
Thyroid Nodule
Obstructive Jaundice
Colon Cancer
Splenectomy for Disease
Intestinal Obstruction
Lung Cancer
Melanoma
34
GRADE SHEET
Student Name _____________________________
Examiner Name____________________________
Date______________________________________
ACUTE----Question #_______
Pathogenesis________________
Anatomy___________________
Diagnosis___________________
Management_________________
GENERAL-Question # ______
Pathogenesis_________________
Anatomy____________________
Diagnosis____________________
Management__________________
ONCOLOGY-Question#______
Pathogenesis___________________
Anatomy______________________
Diagnosis______________________
Management____________________
TOTAL SCORE (Maximum 300)___________
EXAM SCORE (Maximum 100)____________
Signature_______________________________
35
The tables listed below are the cases we expect you to see while on your eight week rotation. You will be completing this on the evalue website. Log into: https://www.e-value.net/ Go to “User Menu” – then “PxDx” – then “add new”. If on same patient, you
saw multiple procedures, you can add multiple listings. After entering all procedures for that one patient, click “next” and “save
record” and repeat for next patient. If unable to login to E*value, send email message to [email protected] for your login and
password. PRINT OUT YOUR PROCEDURE LOG AND BRING W/ YOU TO YOUR ORAL EXAM.
Level I= Student observed examination or management of patient with this disorder OR participated in discussion of patient with this
disorder
Level II= Student examined and presented patient with this disorder to an attending physician or resident
Level III=Student Observed procedure being done
Level IV= Student participated in clinical skill or procedure with Patient, Standardized Patient or Simulation Lab
Level V= Student Performed Clinical Skill or Procedure and was directly observed by attending physician, resident, or standardized
patient
Group Name / Procedure Name+/Clinical Skills/Exam
+/-
Breast exam (Level V)
Patient's H & P (Level IV)
Clinical Skills/Interpretation
+/-
CXR: interpret (Level II)
KUB:interpret (Level II)
Clinical Skills/Procedure
+/-
ABG/Arterial Line (Level V)
CCI (Level I, II, or III)
Central Line: placement (Level V)
Foley Cath: placement (Level V)
IV access/venipuncture (Level V)
Intubation/airway management (Level V)
NG tube placement (Level V)
PVD (Level V)
Sterile Technique (Level II)
Suture (simple) Technique (Level V)
Suture fascia (Level III)
Trauma (Level I, II, or III)
Wound Care (Level V)
Surgery
+/-
Acute Abdomen (H&P) (Level IV)
Acute Abdomen (OR) (Level III)
Acute Abdomen (Post) (Level IV)
Acute Abdomen (SOAP) (Level III)
Biliary Tract Disease (H&P) (Level IV)
Biliary Tract Disease (OR) (Level III)
Biliary Tract Disease (Post) (Level IV)
Biliary Tract Disease (SOAP) (Level III)
Cancer Patients (H&P) (Level IV)
Cancer Patients (OR) (Level III)
Cancer Patients (POST) (Level IV)
Cancer Patients (SOAP) (Level III)
36
Intestinal Operations (H&P) (Level IV)
Intestinal Operations (OR) (Level III)
Intestinal Operations (POST) (Level IV)
Intestinal Operations (SOAP) (Level III)
Laparoscopic Procedures (H&P) (Level IV)
Laparoscopic Procedures (OR) (Level III)
Laparoscopic Procedures (POST) (Level IV)
Laparoscopic Procedures (SOAP) (Level III)
Pre-op a patient (Level IV)
37
The O.R. is located on the 3rd floor of Tulane Medical Center. There are five main areas that you will be involved in: GOR
which has 14 rooms, SDS Dept./Pre-admit (where patients go pre-operatively and post-operative), LLI/Cysto Dept., Recovery
Room and SICU. The GOR is open from 6:45 a.m. – 11:30 p.m. Monday through Friday with emergent cases done after
11:00 p.m. and on weekends. Surgeries start at 7:15a.m. Monday –Friday and 7:45a.m.
You are part of a surgical team whose main objective is to provide quality patient care in a safe environment for staff and
patients. Certain tasks seem mundane but each of us has a significant role and responsibility to meet this purpose. Since
OR’s vary, you are responsible for following policies/procedures of the hospital to which you are assigned.
Your Responsibilities
Come prepared with the knowledge of surgical procedure, anatomy and patient history. You will be asked to assist with
positioning, prepping and possibly draping. If not, once gowned and gloved, stand on the sterile field side of the room.
Scrubs: Tulane Medical Center Scrub Suit Policy and Procedure
Policy:
Tulane Medical Center will provide scrub suits for personnel while they are working in the following areas: Bone Marrow
Transplant, all areas of the Operating Room (Anesthesia, Post Anesthesia Care Unit), Outpatient Surgery, Endoscopy and
Radiology Special Procedures.
Scrub Suits are not to be worn outside the Hospital/Clinic – Medical School complex. They are also not to be worn as
uniforms within departments outside of invasive areas.
Procedure:
Scrub suits are available in jade green and are stamped “Property of Tulane Hospital”. Unauthorized removal from the
facility is a violation of hospital policy.
An automated scrub suit dispensing system will be used in the Operating Room. The system is activated by an identification
card. To receive an activated card, all authorized Tulane employees, physicians and residents must complete an application
form and submit it to the Operating Room management staff. Once form is completed, data will be input to the ScrubEx
system. All users must submit application with a personal identification number (PIN) to use to obtain scrubs. To access
scrub user and pin #: Log in E*Value; Click on the edit button Update Your User Information to retrieve assigned User and
Pin numbers. Scrub Ex machine requires the zero with the user #. If you have any questions, please contact student
coordinator, Stephanie Reed.
Because medical students have a university-issued badge, access to the system will be via the PIN. All forms for medical
school students will be coordinated through the Student Coordinators. If you are at Ochsner or OLOL, you will not use
Tulane scrubs.
Attending faculty and staff will have a credit of two scrub suits. Medical students will have a credit of one scrub suit. Once
this limit has been reached, in order to receive additional scrub suits, previously issued scrubs must be returned to the unit.
Visiting physicians and vendors will be issued scrubs by the Operating Room front desk personnel.
Contact for the Scrub Ex machine:
Linda Levesque, RN MSN CNOR
OR Clinical Systems Analyst Perioperative Services
Tulane University Hospital & Clinic
Office D : 504 988-2469 Mobile C : 504 256-4910
Fax
F : 504 988-7681 Email E-: [email protected]
38
Use New Website------------Matas.Tulane.edu
To access ProceduresConsult
Barbara Volo, MLIS
Monographs Librarian
Rudolph Matas Library of the Health Sciences
Tulane University
1430 Tulane Ave SL-86 New Orleans, LA 70112-2699
504-988-2404
fax 504-988-7417
[email protected]
http://medlib.tulane.edu
From home use off campus login
Sign into Procedures consult with Tulane email user name and password
Do not self register
Please contact Andrew Borgschulte directly to troubleshoot from Procedures Consult
[email protected] . The direct link should be working without going through the
proxy. proceduresconsult.com/tulane; Christie Miller; Regional Account Manager/ Procedures
Consult for Tulane T: 813-579-3880;F: 727-498-5704 [email protected]
<mailto:[email protected]>
39