SURU-4010 - Acting Internship in Urology - Clinical

SURU-4010 - Acting Internship in Urology - Clinical

Elective Title: Acting Internship in Urology - Clinical
Course Number: SURU-4010
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship.
Responsible Faculty Director: J. Nicholas Sreshta, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty: Eduardo Orihuela, MD; Joseph Sonstein, MD; Stephen Williams, MD; Laith Alzweri, MD; Bilal Farhan, MD; Jonathan Gerber, MD
Location to Report on First Day:
Surgery Student Coordinator, Amy White, 6.132 McCullough

1. To gain experience in the evaluation and treatment of patients with urologic diagnosis and treatment.
2. To gain experience in the skills and work habits desirable to function as a house officer on a Clinical Urology service.
3. To participate and learn from weekly conferences, journal clubs, and other lectures.

1. Should be able to perform initial and subsequent patient assessments, write appropriate admission and subsequent orders, and develop management and diagnostic plans for patients with urologic problems.
2. Should gain technical skills in examination, common diagnostic and technical procedures, and operative technique.

Description of course activities
1. Within limits set by law and hospital rules, will function with the same responsibilities and duties as an intern or first year house officer.
2. Will have same hours and call responsibilities as an intern
3. To level that ability demonstrates, will carry same patient load as an intern.
4. Participation in weekly education conferences.
5. Additional didactic presentations given by faculty on various urology topics.

Type of students who would benefit from the course
All students interested in a surgical career or would like to further their knowledge of Urologic problems for a career in medicine, will benefit from this internship.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6:30 5:00
Tuesday 6:30 5:00
Wednesday 6:30 5:00
Thursday 6:30 5:00
Friday 6:30 5:00
Saturday 7:30 - 9:00
Sunday 7:30 - 9:00

 Average number of patients seen per week: 10
 Call Schedule: home call x4 nights/month

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?
    residents and faculty of the division of urology
  B. Frequency / Duration of Presentation(s)?
    Weekly H&P oral presentation (turn in copy for faculty review)
  C. Format - What guidelines are set for the student's presentation?
    case presentations, either powerpoint or word document. Oral case presentations on daily rounds or during check out or patient hand off
  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)?
    weekly H&P presentation in addition to daily progress notes
  B. Format - What guidelines are set for the student's written work?
    daily patient progress notes, word document, or powerpoint presentation
  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.?
    dependent on current patient census
  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 attend radiology conferences, uro-oncology conferences, pathology conferences, and pediatric urology conferences. We expect complete participation in the clinical activities of the Division of Urology.

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.
    Overall student evaluation will be a combination of clinical observation by upper level residents and faculty, in addition to oral presentations and written H&P.

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.
    Verbally when learning surgical skills in the OR or after an oral presentation. Written feedback at the end of the course.

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.
    wound closure, foley catheter placement, cystoscopy, assisting in open surgeries.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    first assistant on OR cases in which faculty are not scrubbed in.

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)?
    They will be responsible for rounding on certain patients and presenting on am rounds. They will close wounds in the OR and help perform consults. There are hospital limitations that preclude placing orders in epic without a resident beside them, but they will practice telling what orders need to be placed.

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?
    familiarity and experience with urologic conditions.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    If deficiencies are identified a midpoint meeting will be called with the student to discuss ways to improve.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There are 4 faculty, each of which have one OR day. They can request clinic time with certain faculty from the chief resident to gain face time with that faculty.

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.
    The AI will have individual time with all core faculty at different times throughout the rotation. This will usually be sufficient enough to yield letters of recommendation. Supervision/interaction will consist of direct one-on-one communication in both the clinic setting ant the OR. If any AI is concerned that they need more individual time with certain faculty, the daily schedule can be adjusted to accommodate. There is also an advanced clinical urology elective that serves more as a one-on-one apprenticeship with an individual faculty on a weekly basis (and we make sure all AI students are aware of this course).