Essentials of Surgery Clerkship

Catalog Description: Required 4- week clinical Clerkship. Designed to provide the learner with a multidisciplinary experience in approaching surgical disease and surgical decision making.

Canvas Site

Sites: Students will be assigned to one of the following clinical sites:

• DU - Essentia Health - St. Mary's Medical Center - 407 E 3rd St., Duluth, MN
• FU - UMMC-Fairview East Bank, 500 Harvard St SE, Minneapolis, MN
• HC - HCMC - 701 Park Avenue South, Minneapolis, MN
• HYB - Primary site attachment with Hennepin Healthcare
• MC - Children's Minnesota - Minneapolis Hospital - 2525 Chicago Ave S, Minneapolis, MN
• MT - Methodist-Park Nicollet - 6500 Excelsior Blvd., St. Louis Park, MN
• NM - North Memorial Medical Center - 3300 Oakdale Ave N, Robbinsdale, MN
• RH - Regions - 640 Jackson St., Minneapolis, MN
• VA - VAMC - 1 Veterans Drive, Minneapolis, MN

Required session attendance: Simulation sessions- 1st week, 2nd week

Typical weekly schedule/Delivery Mode: Varies by site/services; mix of clinic and OR opportunities

Direct patient care: Yes

Consent Requirement: Open to student scheduling

Course Objectives: This course provides the medical students an opportunity to learn various responsibilities of a PGY-1 Surgery resident. At the completion of the rotation it is expected that the student will have achieved competence in the following subject areas:

Gastrointestinal Bleeding

• Identify patient with acute gastrointestinal bleed
• List common causes of GI bleeds
• Justify selection of standard diagnostic and therapeutic studies
• Describe signs and symptoms of hemodynamic instability
• Describe various operations and treatment strategies used to control GI bleeds
• Describe what blood products to transfuse and when
• Write orders for GI consult
• Order endoscopies, labs, radiographic imaging
• Interpret results from the above workup
• Bowel Obstruction
• Identify patients with complete and partial bowel obstructions
• List common causes of bowel obstruction
• Understand usual diagnostic labs and studies
• Describe management and treatment options to deal with bowel obstruction
• Evaluate patient with suspected bowel obstruction
• Complete a thorough abdominal and rectal exam
• Order labs, radiographic studies and management regime
• Interpret evaluation results and physical findings
• Demonstrate proper insertion of Nasogastric tube (NGT) (must be performed with Resident)

Post-Op Management, Complications

• List common post-operative management points
• Justify selection of post-operative labs, diagnostic studies and radiographic studies
• Describe possible post-operative complications and their signs and symptoms
• Specifically describe evaluation of low urine-output, hypoxia and confusion in the post-operative patient
• Describe common doses, uses and modalities of narcotic and non-narcotic pain management
• Write standard post-operative orders including labs, diagnostic tests, radiographic tests and nursing orders
• Write appropriate "call House Officer for…" parameters
• Write and discuss appropriate "prn" orders
• Write for pain management medication (must be performed with Resident)
• Order and interpret appropriate labs, radiographic imaging, studies for evaluation of low urine output, hypoxia and confusion in post-operative patients

Colorectal Cancer

• Identify risks of colorectal cancer
• Justify standard diagnostic evaluations
• Describe signs and symptoms of colorectal cancer
• Describe various operations and treatment strategies for colorectal cancer
• Perform digital rectal exam
• Order laboratory and radiographic studies appropriate to your patient
• Observe colonoscopy, proctoscopy and sigmoidoscopy

Acute Abdominal Pain

• Identify patient with acute abdominal pain
• List common causes of abdominal pain
• Differentiate potentially life threatening abdominal pain from other types of abdominal pain
• Describe standard evaluation labs and studies for acute abdominal pain based on presumed diagnosis
• Recognize a 'surgical abdomen' based on presentation, history and physical exam
• Describe appropriate algorithm for abdominal pain evaluation and work-up
• Perform thorough abdominal exam including rectal exam
• Verbalize differential diagnosis
• Order appropriate laboratory and radiographic studies
• Interpret study results
• Verbalize rationale for narrowing differential diagnoses
• Perform serial abdominal exams including documentation of exam findings (must be performed with Resident)

Pancreatobiliary Disease

• Identify patient with pancreas, liver and biliary disease
• List common types of biliary, hepatic and pancreatic disorders
• Describe signs and symptoms of biliary, hepatic and pancreatic dysfunction
• Justify selection of standard diagnostic and therapeutic studies
• Describe various operative and treatment strategies to deal with diseases of the biliary system, liver and pancreas
• Perform thorough abdominal exam and verbalize pertinent findings
• Order appropriate labs, radiographic and invasive studies
• Verbalize interpretation of study results
• Observe ERCP and evaluate cholangiogram results

Hernia

• Identify patient with hernia (e.g., inguinal, umbilical, incisional, ventral, hiatal)
• List common causes and types of hernia
• Describe signs, symptoms and complications of hernias
• Describe both surgical and non-surgical treatment modalities for hernias
• Perform physical exam for hernia based on location.
• Order appropriate studies and pre-operative evaluation for hernia diagnosis and repair
• Evaluate post-operative hernia patient
• Observe or perform reduction of hernia (must be performed with Resident)

Breast Disease

• Identify patient with breast disease
• List common causes of breast pain, discharge, abnormal mammography and mass
• Describe signs, symptoms and risk factors for breast disease
• Justify selection of standard diagnostic studies
• Describe various operative and treatment strategies for different breast diseases including sentinel lymph node biopsy
• Perform thorough breast exam
• Order appropriate labs and radiographic studies
• Verbalize interpretation of results
• Order appropriate drain and wound care for inpatients and for discharge
• Observe breast biopsy or operation including sentinel lymph node biopsy

Trauma, Burns & Shock

• Identify patient with burns that require medical attention
• Identify patient with signs and symptoms of shock
• List common causes of shock
• Describe various types and pathophysiology of burns and shock
• Justify common laboratory and radiographic studies for burn or shock evaluation
• Describe standard operations and treatments for various types of burn
• Describe various operations and treatment for various types of shock
• Perform estimation of burned body surface area
• Calculate burn resuscitation requirements
• Order appropriate labs, radiographic and invasive studies
• Interpret appropriate laboratory and diagnostic studies
• Perform fluid resuscitation of burn patient or patient in shock (must be performed with a Resident)
• Interpret pulmonary artery catheter data
• Observe or perform central venous catheter placement

Fluid / Electrolytes / Nutrition

• Identify patient with fluid, electrolyte or nutritional abnormality
• Describe common causes of fluid, electrolyte or nutritional imbalances
• Describe various treatments for fluid, electrolyte or nutritional problems
• Order appropriate laboratory evaluations for fluid, electrolyte or nutritional abnormality
• Interpret laboratory findings
• Order fluid, electrolyte and nutritional replacements specific to patient
• Interpret follow-up laboratory findings after intervention

Endocrine Diseases

• Identify patient with endocrine disease
• Describe common causes and types of endocrine disorder
• Justify standard diagnostic, laboratory and radiographic studies to work-up endocrine problem
• Understand complications associated with endocrine diseases with operative therapy
• Describe life-saving therapies
• Describe other operative and treatments available for endocrine disease
• Order appropriate laboratory and radiographic studies
• Interpret results from above studies
• Evaluate post-operative thyroid or parathyroid patient for complications (must be performed with Resident)
• Verbalize treatment for post-operative complications of neck surgery
• Verbalize treatment for post-operative complications of endocrine organ surgical manipulation

Vascular Disease

• Recognize signs and symptoms of atherosclerotic disease (carotid, aortic, and peripheral vascular) and aneurysmal disease.
• Differentiate between underlying vascular disease and other etiologies with similar presentations
• Describe standard evaluation steps and studies (including specific physical exam maneuvers)
• Describe various operations and treatment strategies used to treat patients with vascular disease
• Order appropriate labs and diagnostic studies
• Interpret results from above studies
• Demonstrate ABI (Ankle Brachial Index) exam

Pediatric Surgery

• Identify child with surgical issue
• Justify labs and studies based on surgical problem
• Identify difference between gastroschisis and omphalacele
• List signs and symptoms of emergency surgical conditions
• Perform thorough abdominal exam on a child
• Observe repair of one congenital anomaly
• Observe an inguinal hernia repair

Graded Components: OSATS exam, EPA, GRS evaluation

Grading Scale: P/N