SURU-4061 - Fundamentals of Endovascular Surgery

SURU-4061 - Fundamentals of Endovascular Surgery

Elective Title: Fundamentals of Endovascular Surgery
Course Number: SURU-4061
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Michael B. Silva, Jr, M.D. Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty:
Location to Report on First Day:
Surgery Student Coordinator 6.132 McCullough

Expose students to Vascular Surgery with an emphasis on the evolving field of Endovascular therapeutics.

At the end of this course, students should be able to:

1. Take a history and perform a physical exam on patients with vascular disease

2. Develop assessments and plans for patients with a focus on determining endovascular versus open alternatives

3. Gain vascular access to arteries and veins using ultrasound guidance

4. Comfortably exchange wires and catheters

5. Competently operate a hybrid vascular table with an emphasis on obtaining quality images and performing procedures with the highest possible level of radiation safety.

6. Describe, step-by-step, how to perform an Aortogram with bilateral lower extremity runoff including up and over aortic bifurcation and iliac artery cannulation

Description of course activities
While Vascular Surgery encompasses medical management of vascular disease, open surgical procedures and endovascular therapeutic and diagnostic minimally invasive procedures, this rotation emphasizes skills associated with endovascular surgery. These endovascular skills are applicable to a wide variety of surgical and procedural specialties. Students will learn and practice using ultrasound to gain vascular access for procedures such as central lines, arterial lines, and arteriograms. Simulation using haptic enhanced catheter and computer-generated patient cases with a variety of aorto-iliac and femoral disease will be used to achieve competency in the LSTAR simulation suite. Students will also learn how to both manipulate and run the Siemens Artis Zeego Hybrid Operating room imaging equipment and how to safely perform diagnostic and therapeutic arteriograms under the supervision of faculty and senior residents.

Students should be aware that they may be assigned an off-island location, such as Angleton, Clearlake, League City, or Lake Jackson.

Type of students who would benefit from the course
This course is designed for students interested in learning the foundations of endovascular surgery. This course would benefit students interested in vascular surgery, interventional radiology, interventional cardiology, neurosurgery, and urology.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday Clinic 6:00 Clinic 6:00
Tuesday OR 6:00 OR 6:00
Wednesday Educ. Conf/Didactics 6:00 OR/Clinic 6:00
Thursday OR 6:00 OR 6:00
Friday OR 6:00 OR 6:00

 Average number of patients seen per week: 20
 Call Schedule: N/A

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?
    Faculty & Residents
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    traditional H&P format
  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)?
  B. Format - What guidelines are set for the student's written work?
  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.?
  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 will be expected to attend M&M, grand rounds, didactics and journal club

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.