SURU-4001 - Surgery - Adult Thoracic

SURU-4001 - Surgery - Adult Thoracic

Elective Title: Surgery - Adult Thoracic
Course Number: SURU-4001
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: Abe DeAnda, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty:
Location to Report on First Day:
Either the Surgery Student Coordinator, Amy White, 6.132 McCullough or Cardiothoracic Surgery office 6.120 JSA.

1. To gain experience in the evaluation and surgical treatment of patients with cardiovascular and thoracic disease.
2. To gain exposure and experience in the skills and work habits desirable to function as a house officer on a Adult Cardio-thoracic Surgery service.

1. Should be able to perform initial and subsequent patient assessments, write appropriate admission and subsequent notes and orders, and implement management and diagnostic plans for cardiac and thoracic patients.
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 houseofficer. The student will be the first to assess new consults and new admissions with a full H&P and formulate a proposed plan of care and recommendations. This will then be presented to the faculty using the template attached from the CT surgery protocol. The student will then follow individual patients they have worked up through their hospitalization and/or out patient follow-up including assisting at their operations with ongoing communication with their faculty. Perioperative care can be acted upon by the student following the guidelines of the CT Protocol. This way the student will gain an appreciation of the application of a system of care that provides predictable responses to the predictable problems that occur after cardiothoracic operations.
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 Cardiothoracic Surgery or Cardiology.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6:30 Rounds & Patient.Care; OR Patient Care & OR (usually ends by 5pm)
Tuesday 6:30 Rounds & Patient.Care; OR Patient Care & OR (usually ends by 5pm)
Wednesday 8 am - Grand Rounds, M&M and Case conf. Patient Care & OR (usually ends by 5pm)
Thursday 6:30 Rounds & Patient.Care; OR Patient Care & OR (usually ends by 5pm)
Friday 6:30 Rounds & Patient.Care; OR Patient Care & OR (usually ends by 5pm)
Saturday Rounds

 Average number of patients seen per week: 30
 Call Schedule: Students called only in instance of after-hours case of interest.

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 Senior Residents
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    The following format should be used for presentation on rounds as well as in the patient's progress notes record. On postoperative cardiac surgical patients, a note should be written with documentation of the data below shortly after the patient arrives in the intensive care unit after surgery, and at least once each day thereafter. On all patients in the intensive care unit, the CT resident should have completed or countersigned the full evaluation and have written a complete plan in the chart before morning rounds. After the patient leaves the intensive care unit, an abbreviated version of the evaluation should be used with documentation of data when available and pertinent. All drug interventions should be written in each day's progress note. Additional details re: the format For Postoperative Evaluation will be provided on the 1st day of the course.
  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)?
  B. Format - What guidelines are set for the student's written work?
    Details re: the CT Surgery Protocol will be provided.
  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.?
    Related to cases.
  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)?
    In addition to conference activities listed above, weekly faculty supervised case presentations are done together with the rotating 3rd year students.

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 residents and faculty. We will meet with the student at the end of each week of the rotation in addition to giving constant feedback on individual presentations and discussions.

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.

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.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

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)?

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?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

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.