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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 1 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. 2 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. 3 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 4 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 5 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] 6 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. 7 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. 8 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. 9 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 11 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 12 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