SURU-4065 - Acting Internship in Oral Surgery

SURU-4065 - Acting Internship in Oral Surgery

Elective Title: Acting Internship in Oral Surgery
Course Number: SURU-4065
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: N/A
Responsible Faculty Director: Dr. Roger Throndson Periods Offered: 1-13 including holiday period 8 
Coordinator: Other Faculty: Dr. Hisham Marwan; Dr. Jeffery Garcia
Location to Report on First Day:
6th Floor John Sealy, OMFS Rooms

1. To give a fourth-year student a realistic appreciation of oral surgery including life in the clinic and in the operating room. 2. To give a fourth-year student exposure to all the different subspecialties within oral surgery. 3. To give a fourth-year student applying for an oral surgery residency an opportunity to meet and interact with our chairman and residency director.

At the completion of the three-week elective the student should be able to: 1. Obtain and evaluate the history of a patient with symptoms of disorders of the mouth, trachea, and face. 2. Perform a thorough examination of the above structures. 3. Evaluate and institute the appropriate treatment for the common causes of pain and discharge of the face, mouth, or neck. 4. Evaluate and institute the appropriate treatment for the common causes of dysphagia, pain or discomfort in the throat, lumps on the face and obstruction to the airway. 5. Evaluate and manage trauma of the head and neck regions (e.g., ingestion of foreign bodies, facial fractures, open and closed injuries to the jaw).

Description of course activities
Students will attend clinic daily as assigned M-F and TDC clinic where students participate in patient care. Students should read about clinical entities seen during each clinic day and about those discussed in conferences. There will also be teaching conferences for which attendance is required. Students may also be assigned to see hospital consultations with the consult resident. The duties will comprise working in the outpatient clinics (both adult and pediatric), on the wards and in the operating room. Students will also get the opportunity to scrub in on cases with residents and faculty where they will be tested on anatomy knowledge. Students will also help with any ongoing research projects and help write notes for the residents for practice. As an acting intern, the student is a full-time member of our departmental team and is encouraged to accept a greater degree of clinical responsibility. There will be minimal on call obligation. Call is taken from home. This may include one weekend during the 3-week rotation. We recommend this elective for students contemplating oral surgery as a career choice.

Type of students who would benefit from the course
All types of students, especially those intending a career in oral surgery, ENT, or Facial Plastic surgery.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6:00 6:00
Tuesday 6:00 6:00
Wednesday 6:00 6:00
Thursday 6:00 6:00
Friday 6:00 6:00
Saturday Variable
Sunday Variable

 Average number of patients seen per week: 40-45
 Call Schedule: Variable, will work out schedule individually

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
    Two cases per week
  C. Format - What guidelines are set for the student's presentation?
    Patient presentations, recitations based on provided textbook.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Daily per patient
  B. Format - What guidelines are set for the student's written work?
    Progress notes, resident will review how it is done on day 1
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    student selected or related to cases
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    We expect the students on this rotation to participate fully with all the activities of the department. This includes didactic sessions for the residents and departmental wide conferences like M&M and Grand Rounds.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    In the clinic setting and in the operating room, students will be given immediate feedback regarding their clinical skills. This may involve helpful hints for laceration closure, technical advice on use of our orthognathic equipment, endoscopes, and various dental tools. They will also learn clinical notetaking skills, such as, asking the right questions to reach a diagnosis, and developing trust with patients.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    The AI will have the opportunity to get H&P, present, write progress notes and admit notes as well as post op and pre-op notes. They will also be responsible for explaining procedures and plans to the patient should they have any questions (with resident guidance). They will be able to do a full oral exam as well as procedures like teeth extractions, lipoma excisions, tracheostomies, and laryngoscopies. The will also aid in research that is being done by the department which allows them to get exposure to literature, writing manuscripts/IRB reports, and submitting abstracts, papers, and projects.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    The AI will expand on history taking and diagnostic skills. The AI will be tested verbally on rounds and be given advice on common issues seen in the field as well as more advance cases. The AI will be exposed to more advanced cases and will partake in creating a management plan. They will have more opportunities to scrub in and show surgical skills as well as help teach any third years. They will rotate through the different fields (Oral Surgery, ENT, and Plastics which will give them exposure to all different types of surgeries).

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    Students will be able to scrub in on wisdom teeth removals, free-flaps, ORIF procedures, Hypogastric nerve stimulation procedures, tracheostomies, as well as help in clinic by taking histories and physicals. They will also help present cases to faculty and work on current research that the department is doing. The faculty is also receptive to any research ideas for projects or case reports that the student presents.

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    Students will work comparable hours to what we expect out of our interns while still abiding by the ADA and ACGME Oral Surgery guidelines. Students will review these goals before the beginning of the AI and we will try to make sure that the AI is doing most/if not all of the things we would have our intern doing. They will have more opportunities to present and help deliver care to the patients than a 3rd year student would have.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The students will have the opportunity to get histories and physicals from patients in clinic (outpatient as well as TDCJ). They will use the information they gain to develop an assessment and plan which they will review with the residents and then go over with faculty. While they do not currently have access to placing orders or writing management plans, they will be able to go over this with the resident's and they will show the student's how it is done correctly.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Verbal feedback will be given by the course director, residents, and other faculty. Any striking deficiencies noted by the residents or faculty will be remediated on a case-by-case basis by sitting down with the student and addressing the issue and how to fix it.

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    Students should get a fair amount of time with most of the clinical Oral Surgery faculty. The chair of the department is great at responding to emails and being available weekly during his OR days to discuss with students. The department is small which allows for students to get to know everyone well and spend quality time with both the faculty and residents. Students should get a fair amount of time with most of the clinical Oral Surgery faculty. The chair of the department is great at responding to emails and being available weekly during his OR days to discuss with students. The department is small which allows for students to get to know everyone well and spend quality time with both the faculty and residents.