CORE CLINICAL ROTATIONS
CLINICAL BASIC CORE BLOCK I
Family Medicine, Internal Medicine, Surgery
CCF
BLOCK DESCRIPTION - 2006
Surgery 3rd Year Clerkship
Cleveland Clinic Lerner College of Medicine of Case Western University
LEARNING OBJECTIVES
OVERALL OBJECTIVES ▪ REQUIRED READING
Overall Objectives:
The surgery curriculum is a student-centered clerkship, with a high degree of student-faculty interaction. The student is ultimately responsible to maintain a record of clinical encounters, completing learning objectives, and attending operative experiences.
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Clinical Expectations
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Outpatient clinics
A basic core of surgical experience will be achieved by a broad exposure to the surgical discipline. To accomplish this goal, students will rotate through a variety of surgical specialty clinics that include:
General Surgery
Orthopaedics
Vascular Surgery
Otolaryngology
Pediatric Surgery
Neurosurgery
Urology
Colorectal Surgery
A rotation schedule will be made where students will rotate during Week one and eight during the block. Students will report to two half day clinics per day during each of those weeks.
It is expected that students will evaluate 1 – 2 new patient consults during each half day clinic. Students will have access to the clinic schedule to prepare in advance for each clinic. The emphasis of the student–patient encounter will be a complete, focused history and physical for the presenting problem as well as an assessment and plan for that problem. The goal is to evaluate common problems in a specialty for patients likely to have an operation within 8 weeks. The faculty will direct students to the most appropriate patients. This is not a “shadow experience”; independent patient evaluation and assessment will be preformed by the student.
The student will do a history and physical in Epicare that will be reviewed and critiqued by the staff.
The student and faculty will devise specific learning objectives following the patient encounter to allow for an evidence-based understanding of the disease process and prepare for the planned surgical procedure.
A student assessment form will be emailed to the faculty prior to the operation that will include the H & P and completion of disease specific learning objective(s).
b. Operative experience
Students will maintain a patient list in Epicare to assist tracking of patient results and date of the surgical procedure. Attending the patient’s surgical procedure takes priority over all other clinical responsibilities (this does not include didactic conferences or assessment modules). It is the student’s responsibility to know and attend the time of the procedure. Any confusion regarding this can be resolved by email or page to the attending surgeon.
Participation in the operative procedure is mandatory. Student preparation will be guided by the agreed learning objective. A through understanding of disease process, applied anatomy, surgical risks, complications and outcomes will be expected by the time of the surgical procedure. The student will participate in writing the postop orders, and establish a mechanism to follow the postop course with the surgical team/faculty.
Students will email the faculty an operative assessment form that will include completed learning objectives.
c. Postoperative inpatient care
Students will follow the course of their patients while hospitalized. Rounding on these patients and chart notes will be done prior to other clinical responsibilities. Students will coordinate this activity with the house staff. Students will maintain a log of these postoperative notes. The objective of this student participation will be to demonstrate and assess for common postoperative complications for a given procedure as well as participate in ongoing patient management and decision making.
Patient surgical follow-up will be discussed at the Friday morning clinical conference.
d. On-call responsibilities
Students will take in-house surgical call for 12 hour shifts. A schedule will be provided with students taking 2 shifts Sunday to Thursday, and 4 weekend shifts throughout the entire block. Students will interact on the surgical night call team headed by senior surgical resident. Each student will principally interact with a surgical intern managing either surgical ward inpatients, or ER/surgical consults.
New patient encounters will be kept in a patient log and presented in the Friday morning clinical conference.
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Friday clinical conference
A combined surgical-medical faculty team will lead a clinical conference each week throughout the block. Students will be responsible to present their clinical encounters on a rotational basis. This process will emphasize oral presentation, history taking, assessment of clinical presentations, disease processes, ethical issues, post-operative management and outcomes. Learning objectives may be agreed upon on a weekly basis.
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Assessment of performance
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Patient log
Patients evaluated in the outpatient surgery clinic will have an assessment of the H & P as well as postop course.
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Procedure log
Students will maintain a log of procedures performed as specified by the procedure list.
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Faculty assessment forms
Outpatient clinic
Operative performance
Emphasis on fulfilling learning objectives
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Longitudinal performance in Friday clinical conference
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Oral exam
Structured exam based on 20 common clinical scenarios available to students.
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Written exam
Selected board questions
Required Reading
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Evidence-based Inquiry of Determined Learning Objectives.
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Selected Readings
Cope’s Diagnosis of Acute Abdomen handout
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Textbook
Directed reading of encountered surgical problem
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