SURU-4023 - Acting Internship in Intensive Care Burn Management for the Adult and Pediatric Patients

SURU-4023 - Acting Internship in Intensive Care Burn Management for the Adult and Pediatric Patients

Elective Title: Acting Internship in Intensive Care Burn Management for the Adult and Pediatric Patients
Course Number: SURU-4023
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: Jong Lee, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Other Faculty: Carlos Jimenez, MD Ludwik Branski, MD Steven Wolf, MD
Location to Report on First Day:
Surgery Student Coordinator, Tekeema Franklin, 6.132 McCullough

Goals
1. To gain experience in the evaluation and treatment of patients with burn injury.
2. To gain experience in the skills desirable to function as a house officer on a Burn service.

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

Description of course activities
The student will have the opportunity to function as a surgical intern on the burn service under the supervision of the surgical residents, critical care fellows, and burn faculty. The student will be responsible for patients assigned to his/her care and will make daily rounds with residents, fellows, and faculty. The student will be involved with the admission and work-up of the patient. He/she will take part in the pre- and post-operative care of the patient and assist in operative management. He/she will become familiar with ICU management of the burn patient. The student will be required to attend weekly Surgical Critical Care Conference and monthly journal club. The student will have didactic sessions with faculty.

Type of students who would benefit from the course
All students with interest in burn surgery and critical care.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 6-12 / Rounds and OR 1-4:00 /Clinic/OR and patient care
Tuesday 6-12 / Rounds and OR 1-4:00 /Clinic/OR and patient care
Wednesday 6-12 / Rounds and OR 1-4:00 / Clinic/OR and patient care
Thursday 6-12 / Rounds and OR 1-4:00 /Clinic/ OR and patient care
Friday 6-12 / Rounds and OR 1-4:00 /Clinic/ OR and patient care
Saturday 6-12 / Rounds and patient care
Sunday Either Sat. or Sun. off

 Average number of patients seen per week: 20
 Call Schedule: PRN - no in house.

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other

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.
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty, fellows, and residents.
  B. Frequency / Duration of Presentation(s)?
    Daily.
  C. Format - What guidelines are set for the student's presentation?
    A template regarding important data is provided.
  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)?
    Daily notes.
  B. Format - What guidelines are set for the student's written work?
    Template 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.?
    Student selected and related to cases.
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

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 are expected to attend weekly critical care lectures attended by surgical residents, critical care fellows, and burn attending. They are expected to read about the topics to be discussed in the lectures and participate in lecture discussions and have thoughtful questions.

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".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Clinical performance evaluation by burn 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.
    The student will be given verbal and written feedback.
 
B.
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.
    The student will learn the process of admitting patients and working up of patients.
Perioperative care of patients.
Critical care of patients.
Surgical skills including suturing and knot tying, wound debridement, application of skin grafts, use of skin staples.
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Central line, arterial line, and bronchoscopy.
 
D.
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 acting intern student will have the opportunity to formulate plans for the patients, participate in preoperative planning and postoperative care. The acting intern student will not write orders and will not take night call.
 
E.
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?
    Student will learn to manage patients and learn surgical skills and will learn and be exposed to critical care settings.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Face to face verbal feedback will be provided to the student. Faculty and fellows will work with students in remediating any deficiencies.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There are at least three different faculty on service and the student is expected to encounter the same individual faculty five days a week. The student will work directly with faculty in the operating room and during rounds. The student will work with residents and fellows in the ICU.
 
H.
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 Four faculty will work directly with students during rounds, operations and clinic and provide direct supervision. Written feedback will be provided. Verbal feedback will be provided as needed.