SURU-4070 - Acting Internship in General Surgery at League City Campus

SURU-4070 - Acting Internship in General Surgery at League City Campus

Elective Title: Acting Internship in General Surgery at League City Campus
Course Number: SURU-4070
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship
Responsible Faculty Director: Mike Norman, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty: Jennifer Moffett, MD; Patrick Wallace, MD
Location to Report on First Day:
LCC campus, 4th floor physician workroom

1. To expand clinical skills in caring for general surgery patients in clinic and in-patient settings, including H&Ps, problem-focused assessments of post-operative patients with normal and complicated post-operative events, verbal and written communication of patient status (i.e. H&P/SOAP notes, presentation on rounds), incorporation of evidence into clinical decision-making and management of patients throughout the course of workup and treatment.
2. The student will maintain the same volume of patients on the service as what is expected as a house officer. This would ensure that the student maintain knowledge and understanding of the presentation, workup, treatment and pertinent clinical events of the patient's they are following.
3. To improve and expand upon technical skills.

1. Demonstrate proficiency at information-gathering through communication with healthcare providers, the medical record, history, physical exam, and ordering/interpreting diagnostic tests.
2. Demonstrate the ability to use clinical information to formulate assessments and plans for patients in the clinic and in-patient setting, and accurately communicate clinical information to patients, families, surgical team members, and other healthcare providers.
3. Demonstrate the ability to write initial admission orders, transfer orders, routine in-patient orders, and discharge orders.
4. Demonstrate the ability to perform a safe, accurate and concise hand-off of the patients on the service to a covering provider.
5. Demonstrate proficiency at suturing, knot-tying, fundaments of laparoscopic surgery, fundamentals of endoscopy, and simulated gastro-intestinal anastomosis.

Description of course activities
Within limits set by law and hospital rules, the AI will function with the same responsibilities and duties as an intern or first year house officer. Students will have the same hours and call responsibilities as an intern and will be able to attend Grand Rounds on Wednesdays at 0700 and Morbidity and Mortality conference in Room 6.106 McCullough virtually via Microsoft TEAMS. Students will function as a member of the Acute Care Surgery service at League City Campus and are expected to follow patients on the floor and in the intensive care units and make daily reports on rounds regarding their condition. Such reports are expected to include and assessment of the patients' condition with recommendations for further evaluation or changes in therapy based on that assessment. All students are expected to assist in the operating room and attend the ACS clinic on Thursday afternoons. Students will be assigned at least 2 and no more than 4 overnight calls during the one-month rotation. Students will be expected to see inpatient consults and present to residents and faculty. Students will have the ability participate in technical skills training through the Laboratory for Surgical Training, Assessment and Research (LSTAR), and be expected to practice to proficiency in suturing/knot-tying, fundamentals of laparoscopic surgery, basic endoscopy, and GI anastomosis.

Type of students who would benefit from the course
This course will be especially useful for those students planning careers in general surgery, internal medicine or anesthesia.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday (Rounds and acute care cases) 7:00 5:00
Tuesday (Rounds and acute care cases) 7:00 5:00
Wednesday (Rounds and acute care cases) 7:00 5:00
Thursday (Rounds and acute care cases) 7:00 (1/2 day clinic in PM) 5:00
Friday (Rounds and acute care cases) 7:00 5:00
Saturday (Rounds and acute care cases if on call) 7:00 5:00
Sunday (Rounds and acute care cases if on call) 7:00 5:00

 Average number of patients seen per week: 10/day
 Call Schedule: Students will have at least one day off in seven with no clinical duties or responsibilities. Most of the call will be on weekdays given more OR opportunities unless the student would like to take a weekend call shift; On average, 2 in-house calls per 4-week period

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?
    Faculty and residents
  B. Frequency / Duration of Presentation(s)?
    Daily at morning rounds
  C. Format - What guidelines are set for the student's presentation?
    Similar to what the surgical residents present
  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)?
    H&Ps on at least 2 patients per week, daily notes on at least 3 patients, and a 1 page write-up of a case utilizing appropriate literature to analyze the workup and treatment plan as well as any potential complications of the disease process.
  B. Format - What guidelines are set for the student's written work?
    Similar to the surgery residents
  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?
    Not required but encouraged; Pubmed, UpToDate, textbooks, online resources, etc
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Related to cases would be ideal but could also be student-selected if they have an interest in a disease process.
  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)?
    Students are to participate in those conferences and activities that the surgical team participates in. Students will have the opportunity to present their case report and literature review to the general surgery group during 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.
    Clinical evaluation by faculty as well as technical skills evaluation and an oral exam/discussion of a chosen topic.

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.
    Students will meet weekly with the course director and have a discussion for feedback, as well as review the students' written notes and discuss patients, which will also allow for feedback on fund of knowledge relating to these patients, and feedback on verbal communication skills.

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.
    Handoffs to the group, simulated Epic order entry, laparoscopic simulator at LCC.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Central line simulation and robotic surgery simulator.

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)?
    The AI will be expected to know the clinical status of all patients on the service, including the plan discussed at rounds, follow-up on results from tests, interpretation of results of diagnostic studies, and to communicate results to the team in an appropriate time frame. The student will be expected to recognize when to escalate care or when information needs to be urgently communicated to the resident team or faculty.

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?
    The student will have an opportunity to function as an intern, to experience a more rigorous set of clinical demands, and be supported as he/she develops the knowledge, behaviors, and attitudes to successfully care for surgical patients as part of a resident team.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The course director will meet with the student and discuss the patients they are following on at least a weekly basis.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The course director will meet with the student after soliciting input from the residents and other faculty and give direct face-to-face feedback, including a plan for either remediation or continued skills development.

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.
    There are 3 core faculty on the ACS service at LCC that round daily, see consults and operate. Feedback from the resident team will also be solicited to assist with supervision.