Surgery Clerkship


Introduction­­­­­­­­­­­­­

Welcome to the third year General Surgery Clerkship at NYU Lutheran Medical Center. We hope that this is an enriching and exciting twelve weeks. The aim of the rotation is to provide you with a broad overview and understanding of the practice of Surgery that you will take with you throughout your medical career. Over the course of the clerkship you will be introduced to a wide spectrum of surgical diseases. By following patients from their initial presentation to the ED or operating room through their post-operative care, you will understand the evolution, work up and management of surgical disease processes. Furthermore, you will have the opportunity to develop practical technical and clinical skills. Finally, we hope that you will learn to develop effective relationships with your patients, fellow health care providers and with the hospital staff.

Six to Eight students are assigned to each of the general surgery teams, (Red, Blue, White and Trauma). Students will spend one week on a team before rotating onto a new one. During the rotation you will have the opportunity to see many of the standard and classic operations including appendectomy (open and laparoscopic), colon resection, cholecystectomy, hernia surgery, breast surgery and many more. You will also be exposed to advanced surgery including bariatric, solid organ, foregut surgery, thoracic and plastics. In addition you will have the opportunity to rotate through elective subspecialties such as Orthopedics, Urology and ENT.

 

The core of surgical learning is at the bedside but you are expected to read on your own. This syllabus provides you with a basic outline for your daily work on the rotation and for planning your study time. It is not meant to be your only source of information. Suggested text books are listed below.

 

This clerkship is conducted under the supervision of the Chief of Surgery at NYU Lutheran and Vice Chair of Surgery at NYU, Dr. Kenneth M. Rifkind, M.D. the Dean of Medical Education, Dr. Claudia Lyon and the Clerkship Director, Dr. Mohan Kilaru.

 

Core Faculty: Mohan Kilaru, Michael Timoney, Galina Glinik, Rabih Nemr, Sharique Nazir, Anthony Kopatsis, Robert Davis

Objectives

•Acquire the knowledge and skills necessary to care for the surgical patient.

•Understand common surgical problems and principles.

•Be able to interview the surgical patient and elicit a pertinent history.

•Conduct a complete physical exam.

•Write clear and informative notes in the patient’s chart (initial H and Ps, postoperative checks, daily progress notes).

•Interpret common radiological and laboratory data.

•Formulate a differential diagnosis and treatment plan.

•Understand surgical decision-making, including work up, medical management, timing and need for an operation, and the decision to not operate.

•Become exposed to various surgical subspecialties.

•Be able to communicate your treatment plan to the patient (patient education, informed consent) and to other services.

•Learn basic surgical technical skills.

•Understand operative technique, surgical anatomy and pathology.

•Understand and experience out-patient surgical care and its continuity with in-patient treatment.

•Demonstrate professional behavior (honesty, responsibility, respect for your patients and colleagues, commitment and enthusiasm toward learning).

 

 

Expectations & Responsibilities

The student’s primary responsibility is to acquire the essential surgical knowledge that any physician should have to be able practice within the health care system and which (at present) will make him/her an effective member of the surgical team.

 

1.Didactic sessions

i.Scheduled student conferences (see attached calendar)

ii.These are your primary responsibility. If you are involved in another activity (surgery, clinic, Trauma code, etc.) you may ask permission to be excused to go to lecture.

 

 

2.Participating in patient care

i.Scrub on assigned procedures.

ii.**Remember, it is more important that you “learn” rather than “do” at this stage of your development.

iii.Clinic assignments.

iv.Floor responsibilities.

v.Each student should be following 1-2 patients and should present them on rounds.

 

 

3.Additional reading on your assigned cases and patients

i.You have an absolute responsibility to read about your patients, your assigned surgeries and, other fundamental topics that you may not be fully exposed to.

ii.Basic reading should be from a medical student textbook. More advanced reading can be in the form of resident textbooks and journal articles (please see below)

 

 

4.Gathering data on the patient

i.The surgical history and physical exam.

ii.Essential laboratory and ancillary testing.

iii.Formulating your own differential diagnosis.

 

 

5.Communicating

i.Presenting pertinent information to intern, resident attending, or the group.

ii.Comparing your differential diagnosis to that of more experienced team members.

 

 

6.Monitoring

i.Observing the clinical course of your assigned patient.

ii.Daily rounds.

iii.Chart and information system review.

iv.Assist in daily needs of your patient.

 

 

7.Attendance

i.ONE HUNDRED PERCENT ATTENDANCE is expected from all clinical clerks. Permission to be absent must be obtained from the course coordinator.

ii.Course Coordinator and Chief resident must be made aware of your absence.

Surgery Coordinator: Kristy Villa (718) 630-7351 kvilla@lmcmc.com

 

Rounding

As an active member of your surgical team, you should present your patients on rounds. Patient presentation is an art. A good presentation requires perspective and an understanding of the patient’s problem. At your level, it also requires preparation and rehearsal to organize and focus the presentation, and to keep it brief (<5 minutes). Presentations are to be made without notes if at all possible. This is the “gold standard” and takes time and effort to accomplish. Your House Officers know that they are expected to help you, but you must also rehearse and practice on your own.

 

Downtime

If you have time between assignments you should offer to help with the floor work. If the work of the moment is done, you should take time to read. It is expected that you will inform your resident of your whereabouts so that you can easily be contacted to participate in patient care.

 

 

Teaching Rounds Schedule

Pre-rounds 

Students should arrive at the Hospital at the same time as their intern, generally about 5:30 AM. During this time the student should see and examine each patient she/he is following, and gather any information about events overnight.

5:30-7:00 AM 

Work rounds with the House staff. This is the time for the intern and resident to assess the patients and to make plans for the day. You will be expected to contribute the information you have gathered, your interpretation, and your ideas about what is to be done next. Presentations should be made in the SOAP note format.

7:00 AM-8:30 AM 

Morning report

7:30 AM 

Start time for the OR

12:00  

 Student Conferences (a calendar is attached). You are expected to read for these lectures and be prepared to ask and answer appropriate questions.

TBA

Afternoon rounds and teaching rounds

 

Independent Learning (ASK-ME)

 

 

Conference Schedule

Attendance at all departmental lectures and didactic sessions is mandatory and these talks take priority over other activities. The only acceptable excuse for missing a lecture is that you were scrubbed in on a case.

7:00AM 

Daily morning report with the Chairman and faculty occur at 7:00 am sharp on Monday, Tuesday, Wednesday, and Friday in the auditorium

7:00AM

The Department of Surgery Grand Rounds and Morbidity and Mortality Conference are held Thursday mornings also in the Auditorium.  Proper attire is expected at Thursday conference. Consult your service chiefs regarding topics that will be covered

12 NOON

Didactic sessions with the faculty are typically held on Monday, Wednesday and Friday at Noon. Check your lecture schedule for other lectures and times. 

8:00AM 

Tumor Board; Tuesday

TBA 

GI Conference

 

Reading:

You should prepare yourself by reading the appropriate chapter from your textbook in advance of the talks. The Curriculum topics are derived from the required textbook:

Required Reading for Lectures:

•Essentials of General Surgery by Peter F. Lawrence, 4th edition. This is the standard medical student text for surgery

 

Suggested Reading:

•Many students also find NMS Case Book by Bruce E Jarrell to be a useful ancillary.

•Surgical Recall is a pocket book that has a place but is by no means a substitute to a real textbook.

•Higher level texts include Schwartz’ Principles of Surgery, Sabiston’s Textbook of General Surgery, Greenfield’s Surgery and Cope’s Early Diagnosis of the Acute Abdomen.

 

 Student Curriculum website: http://www.Accesssurgery.com

Username: lmc Password: medicine

 

 

Procedures

Expected skills to be performed:

  •          IV placement
  •          Arterial blood gas
  •          NG tube
  •          Foley catheter
  •          Repair of simple laceration

 

Please find a list of surgical procedures that are mandatory for you to scrub on or observe during the rotation.

 

  •          Appendectomy
  •          Breast lumpectomy
  •          Mastectomy
  •          Open/Laparoscopic inguinal hernia
  •          Cholecystecomy
  •          Gastric Bypass
  •          Colectomy
  •          Exploratory Laparotomy
  •          Tracheostomy
  •          Angiogram, angioplasty
  •          Video Assisted Thorascopic Surgery
  •          Bronchoscopy
  •          EGD
  •          ERCP

 

It is your responsibility to make sure you at least observe these cases during the rotation.  If there is a case that is not on your team, you may ask the attending and resident permission to observe or scrub in. Remember, the best way to derive a benefit from scrubbing into a surgery is to read about it before and after the case.

 

 

Exams/Presentations

While you are on the Surgery Core Rotation you will be evaluated by several methods:

  • Surgeons and Surgery Residents: You will work with a number of surgeons and surgery residents. These experiences will form the basis for completion of an evaluation form of your basic fund of knowledge, clinical competence, technical ability and interpersonal relationships.
  • Advisory Evaluations: You will have advisory evaluations periodically by one of the attending surgeons that will include:
  1. Didactic strengths and weaknesses
  2. Clinical strengths and weaknesses
  3. Ability to work on a team and within the hospital system
  4. Areas for improvement
  • Written Exam: An exam is administered according to individual school policies.
  • Final Grade: Your final grade will be assigned based on your performance on the written exam and evaluations.

 

 

 

Overnight/ On-Call Schedule

Medical students are on-call every 5th night. Be as active as you can during your call nights. You should try to attach yourself to either the Intern or the Consult resident. You are expected to respond to all Trauma calls. The on call experience is a great time to experience and understand how patients present to the ED, how they are worked up as well as, how to understand and respond to surgical emergencies. This is also the time when you will be able to perform many of the procedures of which you are expected to become competent. The resident may page the student if they need help or if something interesting comes in that they think is educational for the student.