SURU-4007 - Acting Internship in Pediatric Surgery

SURU-4007 - Acting Internship in Pediatric Surgery

Elective Title: Acting Internship in Pediatric Surgery
Course Number: SURU-4007
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: Ravi Radhakrishnan, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Karley Garcia Other Faculty: Bindi Naik-Mathuria, MD Carmen Mora, MD
Location to Report on First Day:
Karley Garcia, Res Bldg 6, 3.220

1. To gain experience in the evaluation and treatment of pediatric surgical patients.
2. To gain experience in the skills desirable to function as a house officer on a pediatric surgical service.

1. Perform Patient Assessments: Students should conduct thorough preoperative evaluations, including history taking and physical examination, to formulate and present differential diagnoses for pediatric surgical conditions in the outpatient setting. They will be expected to complete a minimum of 5 of these assessments.
2. Assist in Surgical Procedures: Gain hands-on experience by assisting in a variety of pediatric surgical operations, understanding the steps, techniques, and decision-making processes involved. They will be expected to participate in a minimum of 10 operations.
3. Postoperative Care and Management: Learn to manage postoperative care, including pain management, wound care, and identification of complications in pediatric surgical patients.
4. Family-Centered Communication: Develop skills in communicating complex surgical information to patients and their families in an empathetic, clear, and concise manner, respecting their needs and preferences.

Description of course activities
The student will have the opportunity to function as a surgical intern on the pediatric surgical service under the supervision of the surgical residents, pediatric surgery fellows, and 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 preop preparation and postop management of pediatric surgical patients. The student will be required to attend weekly Pediatric Surgical Didactic Conferences. The student will have didactic sessions with faculty/fellows.

Type of students who would benefit from the course
All students with interest in pediatric surgery.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 6A - Rounds/OR/Clinic 5P - Rounds/OR/Clinic
Tuesday 6A - Rounds/OR/Clinic 6A - Rounds/OR/Clinic
Wednesday 6A - Rounds/OR/Clinic 6A - Rounds/OR/Clinic
Thursday 6A - Rounds/OR/Clinic 6A - Rounds/OR/Clinic
Friday 6A - Rounds/OR/Clinic 6A - Rounds/OR/Clinic
Saturday Either saturday or Sunday off
Sunday Either saturday or Sunday off

 Average number of patients seen per week: 30
 Call Schedule: No

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?
    Surgical Residents, Pediatric Surgery Fellows, Pediatric Surgery Faculty
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Utilizing standard SOAP format for presentations. Students will be coached on important data for pediatric surgical patients
  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 written notes
  B. Format - What guidelines are set for the student's written work?
    Template notes provided in EPIC
  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 cases related to cases seen on service
  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)?
    Students are expected to attend weekly pediatric surgery didactic lectures attended by surgical residents, pediatric surgery fellows, and attendings. They are expected to read about the topics to be discussed in the lectures and participate in lecture discussions and have thoughtful questions. In addition, they are expected to read and prepare for cases in the OR and in clinics.

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 performance evaluation by faculty and fellow.a

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 written and verbal feedback throughout their rotation.

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 assessing and working up pediatric surgical patients.
Perioperative care of pediatric surgical patients.
Assessment of patients in outpatient and inpatient settings.
Surgical skills including suturing and knot tying.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Student will learn specific management of pediatric surgical patient, including but not limited to fluid management, pain control, diagnostic tests to order, and communication with parents regarding child's status.

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.

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 pediatric surgical patients and learn surgical skills such as suturing and knot tying as well as handling delicate tissues.

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.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There are three different faculty on service and the student is expected to encounter each of these faculty during the week in the OR, ambulatory setting, and inpatient settings. The student will work directly with faculty and fellows in the operating room and clinics. The student will work with faculty, residents and fellows on the wards.

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 three faculty will work directly with students during rounds, OR, and clinic and provide direct supervision. Written feedback will be provided. Verbal feedback will be provided as needed.