SURU-4044 - Breast Surgical Oncology at MD Anderson

SURU-4044 - Breast Surgical Oncology at MD Anderson

Elective Title: Breast Surgical Oncology at MD Anderson
Course Number: SURU-4044
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: Successful completion of Surgery Clerkship. C Form is required to enroll 45 days prior to start date, send to Fran Dawe,
Responsible Faculty Director: Cristina Checka, MD & Dr. Richard Ehlers Periods Offered: 5 & 6  excluding holiday period 8 
Coordinator: Fran Dawe Other Faculty: Multidisciplinary faculty
Location to Report on First Day:
MD Anderson League City, 2280 Gulf Freeway, League City, TX 77537

Develop a focused fund of knowledge about the surgical treatment of broad base of breast diseases, including both benign and malignant conditions with a rotation at the MD Anderson League City location.

1. Gain familiarity with benign breast disease (cysts, papillomas, mastodynia, granulomatous mastitis, Zsuska's disease) and the appropriate surgical (and medical) treatments. 2. Learn about the multidisciplinary treatment of breast cancer and develop treatment plans within an integrated team setting. 3. Master understanding of the surgical treatment options for both early-stage and locally-advanced breast cancer. 4. Learn about pertinent breast imaging and breast pathology topics. 5. Correctly perform multifactorial breast risk assessment. 6. Learn about risk factors for breast cancer including genetic mutations and high risk pathology lesions such as atypia. 7. Identify clinical trials appropriate for breast patients.

Description of course activities
1) Clinic Monday, Tuesday, and Friday with MD Anderson breast surgeons at MD Anderson League City Building 2) OR cases at MD Anderson in the TMC. 3) Clinic experiences with radiation oncology, medical oncology, pain service, physical therapy, and body imaging at MD Anderson League City.4) Exposure to specialized services like Clinical Prevention Clinic and Breast Imaging at the TMC. 5) Attendance and participation at a variety of case conferences and departmental grand rounds both in our center and at the TMC (teleconference shall be offered, when possible). 6) Presentation of one case per week at MD Anderson League City Center-wide IDR (Interdisciplinary Rounds) with particular focus on one of the following: identification of psychosocial needs which may impact treatment, identification of an appropriate clinical trial which, description of a diagnostic study which would be indicated, or discussion about appropriate post-treatment surveillance plan. 7) Develop comfort in developing treatment and surveillance plans in a multidisciplinary, team fashion within our center

Type of students who would benefit from the course
1. Fourth year medical students who have completed their general surgery and internal medicine core clerkships. 2. Students who may have an interest in specialist training in hematology/oncology, radiology/breast imaging, radiation oncology, plastic surgery. 3. Any students planning a career in primary care (family medicine, med/peds, internal medicine, geriatrics, or gynecology) who would like greater familiarity with breast disease, including surveillance and treatment of late effects

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 7:30 am 5:00 pm
Tuesday 7:30 am 5:00 pm
Wednesday 7:30 am 5:00 pm
Thursday 7:30 am 5:00 pm
Friday 7:30 am 5:00 pm

 Average number of patients seen per week: 10-12
 Call Schedule: none

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?
    Daily, during outpatient clinic
  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?
    Center-wide presentation at IDR (Interdisciplinary Rounds) which is attended by surgical oncology, urology, gynecologic oncology, medical oncology, radiation oncology, social work, pain service, physical therapy
  B. Frequency / Duration of Presentation(s)?
    one 3-5 minute case per week
  C. Format - What guidelines are set for the student's presentation?
    Individual faculty member shall provide example of appropriate template and assist student in preparing for the presentation, as needed
  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)?
    One comprehensive written H&P shall be submitted by the conclusion of the rotation.
  B. Format - What guidelines are set for the student's written work?
    The H&P shall focus on appropriate history-taking, thorough discussion of different diagnoses, and the tumor-specific laboratory tests and imaging studies which help refine the list of differential diagnosis.
  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.?
    Relate to current case
  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)?
    Will be asked to complete a rotation assessment at the end of the rotation. Weekly center-wide (IDR) (Interdisicplinary Rounds) on Friday at 7:30am, site-specific case conferences (teleconference where possible), departmental grand rounds & site-specific didactic lectures (teleconference where possible).

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.

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.