SURU-4025 - Acting Internship in Vascular Surgery

SURU-4025 - Acting Internship in Vascular Surgery

Elective Title: Acting Internship in Vascular Surgery
Course Number: SURU-4025
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 3
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship.
Responsible Faculty Director: Christine Shokrzadeh, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty: Michael Silva, MD; Mitchell Cox, MD; Eric Whittington, MD; Ruth Bush, MD; Shariq Zaidi, MD; Jani Lee, MD
Location to Report on First Day:
Surgery Student Coordinator, Amy White, 6.132 McCullough

1. To gain experience in the clinical presentation, evaluation and treatment of patients with peripheral vascular disease.
2. To expand clinical skills in caring for vascular surgery patients in outpatient and inpatient settings including focused assessments of these patients that also encompass note-writing, presentation on rounds, incorporations of evidence-based decision making.
3. To increase the students' exposure to outpatient vascular surgical procedures.
4. To improve and expand technical skills in the operating room in both open and endovascular surgeries.

1. Perform initial and subsequent patient assessment, write admission/consult notes, daily progress notes and outpatient notes.
2. Evaluate patients and formulate diagnostic plans for patients on vascular surgery service.
3. Demonstrate the ability to write initial admission orders, transfer orders, routine inpatient orders, and discharge orders.
4. Gain skills in examination and evaluation of vascular patients.
5. Gain technical skills for open and endovascular surgeries in the operating room.

Description of course activities
Within limits set by law and hospital rules, student on this acting internship rotation will function with the same duties and responsibilities as an intern or first year house officer of vascular surgery. The students are expected to be in attendance on Wednesdays at 0700 for Morbidity and Mortality conference, Grand Rounds with general surgery department; as well as vascular surgery division conference and educational programs on Wednesdays at 0930. Vascular surgery education programs include faculty lectures, technical skills training such as suturing/knot-tying, anastomosis, and endovascular surgical skills.
Students will be fully integrated into the vascular surgery team and are expected to follow patients on the service census in Jennie Sealy Hospital and the TDCJ hospital at the same level as an intern. All students are expected to assist in the operating room, attend outpatient clinics, and participate in outpatient venous procedures. Students are expected to see inpatient consults and present to residents and faculty. There are no in-house calls for this rotation. Students are expected to participate in clinical activities 6 days per week

Type of students who would benefit from the course
This course is designed for students who are interested in a career in vascular surgery.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 0600 OR 1700 OR
Tuesday 0600 OR 1700 OR
Wednesday 0700-11:30 Conference 1300-1700 Outpatient Clinic
Thursday 0700 clinic 1700 clinic
Friday 0600 OR 1700 OR
Saturday 0700-1100 Rounds Time off
Sunday Rounds

 Average number of patients seen per week: 35
 Call Schedule: no

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?
    Chief Resident on morning rounds. Attending on evening rounds
  B. Frequency / Duration of Presentation(s)?
    1 patient per day
  C. Format - What guidelines are set for the student's presentation?
    Brief summary of the history and physical examination. Most of the presentation will be spent arriving at a diagnosis and the differential diagnosis.
  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)?
    H&P on alternate new patients and daily notes on assigned patients.
  B. Format - What guidelines are set for the student's written work?
    Format will be discussed with the student on arrival
  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.?
    Content will be related to cases and related problems.
  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)?
    During the elective, the student is expected to attend daily unless it is excused. The student is expected to attend Grand rounds, M&M Conference and participate in all the activities on the service.

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.
    The student will receive written feedback at the midpoint and at the end of the acting internship. This will address clinical skills in and out of the operating room as well as professionalism, communication skills, and effective use of health care resources. This feedback will be similar to how interns are evaluated.

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 acting intern will have the opportunity to practice taking histories, performing physical exams, seeing consultations in the hospital, writing admission orders, assisting at vascular surgical operations, suturing of skin and subcutaneous tissues, knot tying, assisting with endovascular procedures (wire management, catheter advancement, angioplasty balloon inflation, percutaneous femoral artery closure).

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    The skills learned during the vascular surgery acting internship will be applicable to a number of surgical fields. The acting intern may have the opportunity to assist with amputations, ligation of blood vessels, using electrocautery during dissection of tissue, and advanced suturing.

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)?
    In most daily activities, the acting intern will mirror the activities of a PGY1 intern, including seeing hospital patients independently and reporting to the chief resident, performing dressing changes without supervision, and acting as a first assist in the operating room. The acting intern will not be able to directly place orders, write prescriptions, or obtain informed consent.

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 preoperative and postoperative care of a surgical patient and the intraoperative skills associated with this acting internship should be useful in the fields of general surgery, cardiac surgery, vascular surgery, plastic surgery, neurologic surgery, orthopedic surgery, urologic surgery, and gynecologic surgery.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The skills learned during the vascular surgery acting internship will be applicable to a number of surgical fields. The student will receive written feedback at the midpoint and at the end of the acting internship. This will address clinical skills in and out of the operating room as well as professionalism, communication skills, and effective use of health care resources. Any deficiencies noted at the midpoint will be discussed with the student and a specific plan.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    The student will work with four faculty members and will work with most of them on a daily basis. During a month-long rotation, the student can expect to work with each faculty member for 15 days. The acting intern will have interaction with the third-year medical students, the intern, and the chief resident. The faculty will be actively involved in the supervision of the acting intern, in and out of the operating room and will be primarily responsible for the overall evaluation of the resident at the midpoint and for the end of the rotation.

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.