SURU-4059 - Acting Internship in General Surgery - Tyler

SURU-4059 - Acting Internship in General Surgery - Tyler

Elective Title: Acting Internship in General Surgery - Tyler
Course Number: SURU-4059
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: Successful completion of Surgery Clerkship. C Form required to register, send to Tyler Coordinator, Megan Pazos,
Responsible Faculty Director: Dr. Hishaam Ismael Periods Offered: 1-6, 9-13 including holiday period 8 
Coordinator: Megan Pazos Other Faculty:
Location to Report on First Day:
UTHSCT (North Campus) Tyler

1.To expand clinical skills in caring for general surgery patients in clinic and inpatient settings, including H&Ps, problem-focused assessments of post-operative patients with normal and complicated post-operative events, verbal and written communication of patient status (i.e. H&P/SOAP notes, presentation on rounds, incorporation of evidence into clinical decision-making and management of patients throughout the course of workup and treatment. 2. To increase the volume of patients on a service for which the student can maintain knowledge and understanding of presentation, workup, treatment and pertinent clinical events, to the level required as a house officer. 3. To improve and expand upon technical skills.

1. Demonstrate proficiency at information-gathering through communication with healthcare providers, the medical record, history, physical exam, and ordering/interpreting diagnostic tests.
2. Demonstrate the ability to use clinical information to formulate assessments and plans for patients in the clinic and inpatient setting, and accurately communicate clinical information to patients, families, surgical team members, and other healthcare providers. 3. Demonstrate the ability to write initial admission orders, transfer orders, routine in-patient orders, and discharge orders. 4. Demonstrate the ability to perform a safe, accurate and concise hand-off of the patients on the service to a covering provider. 5. Demonstrate proficiency at suturing, knot-tying, fundamentals of laparoscopic surgery, fundamentals of endoscopy, and simulated gastro-intestinal anastomosis.

Description of course activities
Within limits set by law and hospital rules, will function with the same responsibilities and duties as an intern or first year house officer. Students will function as a member of one of the adult general surgery teams and are expected to follow patients in the intensive care units and make daily reports on rounds regarding their condition. Such reports are expected to include an assessment of the patients condition with recommendations for further evaluation or changes in therapy based on that assessment. All students are expected to assist in the operating room and attend all outpatient clinics. Students will be assigned at least two and no more than four overnight calls during the one-month rotation.

Type of students who would benefit from the course
This course will be especially useful for those students planning
careers in surgery general surgery, oncology surgery, or thoracic

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 7:00am OR 4:00pm OR
Tuesday 7:00am OR 4:00pm OR
Wednesday 7:00am OR 4:00pm OR
Thursday 7:00am OR 4:00pm OR
Friday 7:00am OR 4:00pm OR
Saturday 8:00am Round with Residents/Faculty
Sunday 8:00am Round with Residents/Faculty

 Average number of patients seen per week: 30
 Call Schedule: On average, 3 in-house calls per 4-week

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?
    Faculty & Residents
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    Same guidelines used by a physician
  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)?
    Weekly H&P's on at least 2 patients, daily notes on at least 3 patients, and a 1-page write-up of a case, synthesizing medical literature to analyze workup and treatment plan, as well as potential complications
  B. Format - What guidelines are set for the student's written work?
    Same as used by physicians
  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?
    At least one article from a pubmed search, and other additional sources are acceptable - textbooks, up to date, etc.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Content will be selected that relates to a case the student scrubbed in on.
  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 to participate in those conferences and activities that the surgical team to which they are assigned participate. Students will present their case report and literature review to the general surgery team during teaching rounds.

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 faculty; oral exams

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 keep a journal to document feedback they
have sought out from residents and faculty; they will meet weekly with course director and have a discussion of this
feedback, as well as a review the students written notes
and discuss patients, which will also allow for feedback on fund of knowledge relating to these patients, and feedback
on verbal communication 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.
    Hand-offs Laparoscopy (simulation lab and/or OR) Endoscopy (simulation lab, and OR/GI lab) gastro-intestinal anastomosis (simulation lab) order-entry in EPIC simulation lab for now.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Central line placement (simulation lab) robotic surgery (simulation lab)

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)?
    Similar - the acting intern will be expected to know the clinical status of all patients on the service, including the plan discussed at rounds, follow-up on results from tests,
interpretation of results of diagnostic studies, and to communicate results to the team in an appropriate time frame. The student will be expected to recognize when to
escalate care or when information needs to be urgently
communicated to the resident or faculty. Differ - the student will not be able to enter orders in the EMR on active patients.

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 will have an opportunity to function as an intern, to experience a more rigorous set of clinical demands, and be supported as he/she develops the knowledge, behaviors and attitudes to successfully care for surgical patients as part of a resident team.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The course director will meet with the student after soliciting input from the residents and other faculty and give direct face-to-face feedback, including a plan for either remediation or continued skills development.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    There are 4-5 faculty on each general surgery team; the acting intern should endeavor to attend clinic with each
faculty at least once during the rotation and scrub cases with each faculty. The student should see faculty 2-3 times per week.

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.