Non-VSLO External Elective Process
Acting Internship in Surgery-Transplant Surgery
Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship. (Period 1 max enrollment is 2)
Responsible Faculty Director:
Michael Kueht, MD
Trine Engebretesen, MD; Luca Cicalese, MD; Rupak Kulkarni, MD
to Report on First Day
Surgery Student Coordinator, Tekeema Franklin, 6.132 McCullough
including holiday period 8
|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)|
|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|
|Other Observation of/participation in operative procedures, direct patient care||8-10 hours|
|1. Clinical Observation|
|A.||Where are students observed on this elective?|
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
|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|
Written multiple choice
Written essay / short answer
|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.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
Difference - students cannot write progress notes and will need the intern to edit the student notes.
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?
|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 is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
|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.|
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
|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).|
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.