SURU-4016 - Acting Internship in Surgery-Transplant Surgery

SURU-4016 - Acting Internship in Surgery-Transplant Surgery

Elective Title: Acting Internship in Surgery-Transplant Surgery
Course Number: SURU-4016
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship. (Period 1 max enrollment is 2)
Responsible Faculty Director: Michael Kueht, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty: Trine Engebretesen, MD; Luca Cicalese, MD; Rupak Kulkarni, 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 end stage renal disease, renal and pancreatic transplants and general surgery patients.
2. To gain experience in the skills and work habits desirable to function as a house officer on a Transplant-Surgery service.

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 renal and transplant 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.

Type of students who would benefit from the course
This course will be particularly useful for those students who have a strong interest in or plan a career in Transplantation or internal medicine (specifically the subspecialty of nephrology)

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Clinic or rounds/patient care/or reading rounds/patient care/or reading
Tuesday OR &/or patient care OR and rounds
Wednesday conferences meeting with attending/ patient care/ OR
Thursday Clinic or rounds/patient care/or OR OR and patient care
Friday OR &/or patient care OR and rounds
Saturday rotation of call
Sunday rotation of call

 Average number of patients seen per week: 14
 Call Schedule: about once a week

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 8-10 hours
Self-Directed Study 8-10 hours
Data-Collection/Analysis 10-12 hours
Other Observation of/participation in operative procedures, direct patient care 8-10 hours

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 house officers on the service; in the OR and clinics by faculty and residents; Once a week by faculty in the simulation lab or on the floor with patients
  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?
    the transplant team: floor nurses, coordinators, social worker, dietician, residents, other students, faculty (surgeons and nephrology), nephrology fellow
  B. Frequency / Duration of Presentation(s)?
    daily on rounds
  C. Format - What guidelines are set for the student's presentation?
    routine patient presentations; occasional presentation of short topics regarding ESRD or transplant patients/ 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)?
    About 2 H&P per week, daily rounds notes (as allowed by regulations) on 3-4 patients, papers and abstracts as per the students desire
  B. Format - What guidelines are set for the student's written work?
    Standard protocols for H&Ps and notes
  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?
    recommendations by faculty or researched by student
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Student or faculty selected; related to a case or transplant topic
  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)?
    There is an expectation that the student will ask questions, read and report about the patients diseases and treatments; let the residents or faculty know about any task-oriented needs that student has not completed to date (insertion of foleys, IVs, lines, tubes, etc.) and immediately inform the residents or faculty of any abnormalities of lab or diagnostic tests. Attendance of conferences is encouraged.

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.
    Written subjective evaluation of clinical performance by the senior-most resident on the service and transplant surgery faculty. Most of the evaluations will be by oral feedback at the time of presentations and in the OR. Evaluation will also be based on the intellectual curiosity that the student exhibits, especially with the quality of questions asked.

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.
    Written subjective evaluation of clinical performance by the senior-most resident on the service and transplant surgery faculty. Most of the evaluations will be by oral feedback at the time of presentations and in the OR. Evaluation will also be based on the intellectual curiosity that the student exhibits, especially with the quality of questions asked. Weekly meetings with the faculty and feedback on the discussion topics.

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.
    H&Ps on complex patients with end stage disease and/or transplant- develop skills differential diagnosis of complications as well as development of treatment plans. Surgical operative skills of closure of wounds. Simulation training of insertion of central lines, vascular anastomosis.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Insertion of central lines; Incision of skin; basic surgical skills.

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 students will be assigned at least two patient per rotation that they will be responsible for the H&P (will need to follow the rules of the institution regarding EMR use), daily notes, discharge summary and collection of data from diagnostic tests, interpreting the test results, and making decisions of care/therapy. Placing IVs, foley, NG tubes prn


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?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Development of good history and physical exam skills on complex patients; development of medical decision making of diagnoses, diagnostic tests to be ordered, interpretation of the results, and decision of therapy; Having basic surgical skills

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Faculty at the time of the Wednesday meetings. Remediation will be decided by the faculty and recommendations for further reading, simulations, or practice of skills will be assigned.

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.
    3 faculty - each rotates 7 days - student will see one faculty 14 days, the other two for 7 days. Faculty will round daily, be in the OR cases always, and meet with the student for 1-2 hours once a week (usually Wednesday afternoon).