General Information

Third-Year Clerkship Goals

The goals of the third-year surgery clerkship are to assist the student in developing the following abilities and skills:

1. The practice of applying basic science disciplines to clinical situations.
2. To recognize diseases or conditions that are treated surgically. This includes understanding the normal physiology, pathophysiology and changes incurred by surgical treatment. The student will be expected to understand the natural history of surgical diseases and the normal physiology in individuals not affected.
3. To develop problem-solving skills based on a complete history, performance of a complete physical examination and collective interpretation of additional data such as laboratory and X-ray results.
4. To recognize common surgical emergencies and the appropriate responses to these emergencies.
5. To develop basic manual skills required in effective patient care.
6. To develop self-assessment skills that will provide the student with appropriate input or awareness as to his or her performance on the clerkship objectives.
7. To develop and maintain personal characteristics, attitudes and ideals appropriate for the physician and surgeon. This should include an awareness of personal strengths, weaknesses, appearance, reliability, integrity, honesty, and the ability to interrelate with other individuals.
8. To develop skills enabling an effective interaction with patients, colleagues, nurses, and other health care professionals. This includes the development of communication skills that are necessary for the exchange of information concerning patients and the ability to cooperate with other disciplines in patient care.

Objectives

Objectives for specific surgical subjects have been prepared by the Curriculum Committee of the Association for Surgical Education (ASE) and are published in the "Manual of Surgical Objectives: A Symptom and Problem-Based Approach," 4th Edition. These are essentially lists of expected knowledge, skills and accomplishments to be studied for each specific subject. The Department utilizes these objectives for the Third-Year Surgery Clerkship, and students should review the objectives during the clerkship.

Clerkship Orientation

A general orientation to the clerkship will be held by video conference at 4 p.m. Central Time on the first day of each rotation for all students at all three campuses. This orientation will take approximately 30 minutes and will be followed by campus-specific orientation at each campus. Students will meet with administrative staff and faculty; details for each campus are provided.

Clinical Role

Surgical clerkship students (clerks) assume a significant role on the surgical team with supervised responsibility in the care of all patients on the service. The student will perform a complete history and physical examination on each patient assigned, unless otherwise indicated by the attending surgeon.

The surgical clerk is responsible for checking with the attending surgeon or resident and operating room for the time of scheduled surgical procedures. All clerks WILL be excused for assigned Seminars and Examinations. Also, all clerks will participate in scheduled teaching ward rounds that do not interfere with other responsibilities. These times will be designated on the weekly schedule. Attendance (in person or by video conference) at Surgery Grand Rounds and M & M conference is mandatory, and students will not be excused except for illness or other special circumstances.

The third-year clerks rotating on Surgery will be evaluated on the basis of multiple experiences. The clerk is expected to work up two or more patients per week as assigned by preceptors. When assigned a patient with a specific surgical disease or condition, the clerk will be expected to be able to relate pertinent surgical information regarding the disease or condition at the end of the clerkship. Evaluation of the student's performance and cognitive skills will be accomplished through the use of objectives seminars, student case conferences, instructor ratings, and by examinations as outlined in the Department of Surgery evaluation policy.

Call Schedule Policy

Students are expected to take call during the rotation. Call will not exceed every fourth night or fourth weekend, on average. Call may be either in-house or from home via beeper, depending on the location. Each student should discuss facility-specific call policies upon arrival at each facility. On non-call nights, students may leave at 6:00 p.m. (but may stay later if the student desires to do so).

The Department abides by the ACGME 80-hour work week policy.

Skills and Procedures

It is impossible to establish an all inclusive list of technical and procedural tasks performed by third-year medical students. Backgrounds and previous experiences will vary, but all should have had some experience in performance of history and physical examinations, including genital and rectal examinations.

The following skills are part of the surgical clerkship experience and should be initially supervised prior to being performed independently:

• Venipuncture for drawing of blood or initiation of IVs.
• Change of dressings; advancement of drains; removal of sutures or staples.
• Passage of nasogastric tubes.
• Placement of urinary catheters (both male and female).

The following procedures are usually performed by house staff or attending staff, but on occasion, may be performed by students under direct supervision of a staff member:

• Arterial puncture for obtaining blood gases.
• Suture of minor lacerations.
• Skin biopsy.
• Thoracentesis.
• Portions of surgical procedures.
• Airway management.

The medical student must recognize that he or she is both ethically and legally responsible for the care that he or she delivers. Any procedure that he or she undertakes should have been previously discussed with and approved by either a resident or attending staff member.

The medical student must recognize the patient's right to privacy and freedom from undue discomfort or injury. The procedure must be adequately explained to the patient, informing the patient of the need for, and likely results of, and possible discomforts involved in the procedure. Alternate approaches may have to be explained. The student should properly identify themselves to the patient. If the student is not successful in the performance of the procedure within a reasonable amount of time or without undue discomfort to the patient, he or she should withdraw and seek supervision or assistance.

The medical student should be aware that nursing personnel often have greater experience in the performance of some procedures than the student. In most cases, nurses are available and willing to assist and instruct in some of the procedures.

Student Case Logs

Smart phones or PCs will be used to record patients' diseases; operations witnessed and assisted; procedures, skills observed, assisted and performed. These should be entered no less often than weekly; failure to enter cases may result in a failing grade for the rotation. These patient encounters will not be part of the grade; they will, however, be used as a critique of the individual's rotation. Failure to complete the patient encounters or to submit them as requested will result in an incomplete mark in surgery. Detailed instructions on the case log process will be given during orientation.

Minimum requirements for patient encounters

Texts and Manuals

The required texts and manuals are (most recent editions):

1. "Essentials of General Surgery" by Peter F. Lawrence or "National Medical Series (NMS) for Independent Study" Surgery, by Jarrell and Carabasi, III (required)
2. "Cope's Early Diagnosis of the Acute Abdomen" by William Silen (required)
3. "The Manual of Surgical Objectives: A Symptom and Problem-Based Approach, 4th Edition, by the Association for Surgical Education 2001. Link provided by the Association for Surgical Education -  The Manual of Surgical Objectives
4. "TEAM" (Trauma Evaluation and Management) Student Booklet from the American College of Surgeons - www.facs.org (This will be provided to you on first day of rotation).

Helpful links and reference texts (most recent editions):

1. American Urological Association: AUA National Medical Student Core Curriculum
2. "Surgical Anatomy & Technique: A Pocket Manual" by John E. Skandalakis (optional—in preparation for the operating room).
3. "Principles of Surgery" by Schwartz (optional)
4. "Textbook of Surgery" by Sabiston (optional)
5. "Mastery of Surgery" by Nyhus (optional)
6. Online sources from the School of Medicine & Health Sciences Library Resources

History and Physical Exams

The written history and physical examination prepared by the surgical clinical clerk should follow the format in the UND Physical Diagnosis Course Handbook.

Student Performance and Due Process

The Department of Surgery emphasizes the importance of academic honesty and responsibility by the student. The student is specifically referred to in Division II, Standards of Academic Conduct of the Faculty of Medicine.