SURU-4006 - A/I Neurosurgery Clinic

SURU-4006 - A/I Neurosurgery Clinic

Elective Title: A/I Neurosurgery Clinic
Course Number: SURU-4006
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: C-Form required. Successful completion of Surgery Clerkship.
Responsible Faculty Director: Rishi Lall, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Jennifer Low Other Faculty:
Location to Report on First Day:
Surgery Student Coordinator, Jennifer Low, JSA 9.314B

1. To gain experience in the evaluation and treatment of patients with central and peripheral nervous system problems.
2. To gain experience in the skills and work habits desirable to function as a house officer on a Neurosurgery 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 central and peripheral nervous system 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 is particularly valuable for students interested in Critical Care, Neurology, Neurosurgery, Orthopedics, Anesthesia, Neuroradiology, Emergency Medicine and Otolaryngology.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 6:00 6:00
Tuesday 6:00 6:00
Wednesday 6:00 6:00
Thursday 6:00 6:00
Friday 6:00 6:00
Saturday 7:00 noon
Sunday 7:00 noon

 Average number of patients seen per week: 50
 Call Schedule: 1:4 (average student load)

Research / Other Course 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
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Standard patient presentation
  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)?
    Chart notes daily
  B. Format - What guidelines are set for the student's written work?
    Standard physician documentation in the hospital chart
  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
    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)?
    Teaching conferences on Wednesday include neuroradiology, neuropathology, neurology/neurosurgery grand rounds, board review, journal club, and ACGME teaching conference. Student participation is expected and encouraged. It is expected that students have an interest in the clinical neurosciences and will be self-motivated, adult learners.

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 upper-level residents and faculty.

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.
    Students will be given formative feedback as required based on their attendance, participation, demonstration of medical knowledge, and clinical skills. All of this will be verbal feedback.

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.
    Evaluation and management of neurosurgical emergencies and urgent cases. Evaluation and management of elective neurosurgical problems. Participation in the clinic and operating room.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Bedside procedures such as central lines, arterial lines and external ventricular drains. Assisting in the operating room with opening and closing.

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 student will be expected to know, understand and explain pertinent and important data about patients on the service. They will not be expected to make management decisions or evaluate patients independently.

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?
    The student should receive an accurate and realistic picture of what the life of a neurosurgery house officer is like. They should also gain an appreciation for how responsibility changes as one advances in training.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Feedback will mostly be verbal. Deficiencies, if identified, will be dealt with both verbally and in writing with a remediation plan.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Students should gain exposure to all of the full-time neurosurgery faculty. Exposure to an individual faculty member is largely dependent upon effort made by the student to be present. The more effort made by the student, the more exposure they will have to the residents, faculty, and the field.

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 students are encouraged to work with the faculty members depending on the faculty and their daily schedule and the location of their service. The number of faculty working with the students is variable and is largely dependent on the students interest and interaction. The Chief Resident and the other senior and junior level residents interact daily with the student and guide the students during the rotation while the available faculty supervise the process. The residents also provide direct feedback regarding the students performance during the rotation which is then submitted by the faculty/faculties at the end of the rotation. Letters of recommendation are provided by the faculty at the request of the student.