SURU-4008 - Acting Internship in Plastic Surgery

SURU-4008 - Acting Internship in Plastic Surgery

Elective Title: Acting Internship in Plastic Surgery
Course Number: SURU-4008
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship. A C-Form is required to enroll, send to Tekeema Franklin (tefrank@utmb.edu).
Responsible Faculty Director: William Norbury, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Karley Garcia Other Faculty: Ludwik Branski, MD Eric Cole, MD
Location to Report on First Day:
Course Coordinator, Tekeema Franklin, 6.132 McCullough

Goals
To familiarize the student with basic patient care activities in a broad plastic surgery service. To enhance skills in diagnosis and treatment options for patients with a range of plastic and reconstructive issues including: breast, hand, maxillofacial, soft tissue tumor, burn and chronic wounds. Understand more of the physiology of these conditions.

Objectives
To learn technical skills including: evaluation and work-up of skin lesions, appropriate excision with margins and layered laceration closure. To improve skills in the history and physical examinations of severely injured patients. Evaluate multiple types of injuries and acquire knowledge of what can be accomplished with reconstructive surgery.

Description of course activities
Students will be involved in daily work-up and evaluation of patients both in the hospital and in the outpatient clinics. Approximately 40 patients will be seen per week in these settings. They will be given an opportunity to participate in information gathering on in-patients rounds and evaluate patients with residents in the clinic. No pre-rounding will be expected. They will also participate in surgical procedures which will include observation, intra-operative case discussion and hands-on operative activities depending on the student level and case complexity, as described in the above objectives.

Type of students who would benefit from the course
Those planning on going into Surgery, Family Medicine, ENT, Emergency Medicine or Dermatology will particularly benefit from the technical and didactic information. All students could benefit from the basic anatomy, evaluation and physiology of these challenging issues.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Operating room (OR) OR
Tuesday Friendswood clinic Friendswood clinic
Wednesday Grand rounds & OR OR
Thursday Friendswood clinic Wound Clinic, Hand or Journal club conference
Friday Aesthetic Clinic-Friendswood PS Clinic
Saturday
Sunday

 Average number of patients seen per week: 40
 Call Schedule: none

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other

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?
    Daily by both faculty and residents in both operative and clinic settings
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Both to faculty and residents on in-patients, clinic patients, read and present journal articles, hand conference topics
  B. Frequency / Duration of Presentation(s)?
    Daily patient presentations, bi-weekly journal and hand conference topics
  C. Format - What guidelines are set for the student's presentation?
    Patient evaluation followed by presentation orally in rounds or clinic, assigned and hand topics
  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 patient notes and H&P's
  B. Format - What guidelines are set for the student's written work?
    n/a
  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.?
   
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

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

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)?
    The student will participate in morning rounds, take an active roll in the operating room, evaluate and assist in the treatment of clinic patients, participate in division conferences and journal clubs.

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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Carried out by the residents and the staff on a week-to-week basis.

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.
    Student will receive oral feedback in OR, clinic and during rounds.
 
B.
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.
    Advanced assessment and planning.
Layered suturing.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Advanced operative and clinical skills set.
 
D.
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)?
    Use of bovie cautering.
Use of scalpel in the OR.
 
E.
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?
    Responsibilities include rounding, patient presentations and utilizing EPIC to gather patient data.
Students are not allowed to write notes.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
   
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Midpoint feedback provided in paper form, any deficiencies will be addressed.
 
H.
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.
    2-3 faculty are encountered during the rotation for 3 to 5 days per week, however this can easily be tailored to student''''s specific interest.
Student will receive significant interaction with both faculty and residents.