Course Overview

Surgery

Overview

The course generally begins on a Monday and ends on the Friday of the sixth week. University holidays may, of course, alter the exact starting and ending days of this surgical clerkship. Each student will spend their six week rotation on one of our Department if Surgery surgical services. Students will have the opportunity, as much as is possible, to choose the surgical service on which they wish to rotate. Options include the Trauma and Acute Care Surgery service, Gastrointestinal Surgery, General Surgery at the Ralph H. Johnson Veteran's Administration hospital, Surgical Oncology, Cardiothoracic Surgery, Transplant Surgery, Pediatric Surgery, Plastic Surgery, and Vascular Surgery. The course begins at 7:30 AM with an orientation session held in Room 419 of the Clinical Science Building. Following this session, students will proceed to the assigned services to begin their rotation.

Operating Room Experience

We believe that it is important for students to see a wide variety of surgical procedures while on their surgery rotation. All physicians, regardless of career choice, will be exposed to patients who have undergone surgical procedures. We think it is vital that students have some idea of what that procedure involved, even if they will never perform the surgery themselves.

The student logbook, discussed below, lists 12 types of operative cases students are expected to see during their surgical clerkship. Students are required to participate in at least 11 of these 12 procedures. However, this, in no way, implies that students are expected to see only 12 cases. We encourage students to go to the operating room as often as possible both for cases on their own service and for other cases that interest them. Students should be active participants in the operative cases and not just passive observers. The best educational experience comes when a student has seen the patient preoperatively and has read about the problem for which the patient is undergoing surgery. We hope students will scrub for the entire procedure and whenever possible, assist the housestaff in writing the postoperative orders for patients in whose procedures they participated.

The operating room schedule is posted both in the operating rooms and on the OACIS system on the hospital intranet. Students should look at the OR schedule for the following day and plan ahead to know which cases they will be observing. Students should work together to minimize conflicts and assure that all students see as many cases from as many areas of surgery as possible.

Surgery Small Group Sessions

Students are expected to participate in a series of small group sessions with a faculty preceptor during their third year surgery experience. Students will be assigned to small discussion groups headed by a faculty member from the Department of Surgery. This faculty member will also serve as the student's advisor during their rotation. Students should assure that their preceptor's secretary have their pager numbers so that they can be contacted in the event a session is changed or rescheduled, something not at all uncommon in the busy life of a surgeon.

Logbook

Students are also expected to complete the surgical portion of the "log book" found on the web used for this and all other clinical rotations. All students are required to complete the logbook items on real patients. Alternative mechanisms for meeting these requirements are available for the various required diagnoses but may only be used if absolutely necessary. ex. when a specific surgery just cannot be seen. Failure to complete this logbook requirement before the end of the course will result in a withholding of grades.

Conferences

Students are expected to attend several conferences during their surgery core rotations. These include:

Surgery Grand Rounds
Held in the hospital's 2nd floor amphitheater every Tuesday morning at 7 AM. This conference is designed to present the latest information on surgical topics for the surgeon, the resident, and the student. (Note: Grand Rounds are not held over the summer).

Surgery Morbidity and Mortality Conference
Held every Tuesday at 5:00 p.m. in the amphitheater. This conference is used to discuss surgical complications and interesting cases. Students are reminded that this is a quality assurance activity and that any information presented should be held in strict confidence.

Resident's Basic Science Lecture
This mandatory hour-long conference is intended for residents and should not be attended by students. We have found that the conference format does not benefit medical students. This conference is held on Tuesday at 4:00 p.m. During that time you will be free to scrub in on OR cases, attend outpatient clinics, track down information about your patients and pursue whatever other activities you feel would benefit your education or your patients.

Dr. van Heerden's Teaching Hour
Coordinated by Dr. Jon van Heerden, Vice Chair for Education, Department of Surgery, this will be held on one occasion during the rotation which will be announced at the beginning of the rotation.

Anesthesia Conference
On one afternoon of your rotation anesthesia will hold a conference to cover various aspects of anesthesia. Note that this conference is held only once so please record the date on your calendars so that you don't forget this conference.

Visiting Professorships
Every year the Department of Surgery sponsors three visiting professorships. The Biemann Othersen Visiting Professorship in Pediatric Surgery and the Horace Smithy lecture are held each fall and the Kredel-Springs lecture is held in the spring. Renowned surgeons from across the United States have served as invited professors for these prestigious events. All students on the surgery clerkship are expected to attend these rewarding lectures given by world renowned experts in their fields. Students are also expected to attend the day long events preceding the actual lecture.

The weekly grand rounds and the three annual visiting professorships are advertised throughout the hospital and are open to any MUSC College of Medicine student with an interest in surgery or in the topic being presented regardless of their current level of training or current clinical rotation.

On Call

During the surgical clerkship, students will take in-house call approximately 5 or 6 times. While "on-call", students will be paged for all trauma admissions to the Emergency Department and should report to the Emergency Department whenever a "trauma alert" is received over their pagers. However, students are strongly encouraged to pursue other opportunities as well. They may participate in any operative procedures taking place during the night whether on a general surgery service or one of the specialty services. Time can be spent with the anesthesiologists to gain a better understanding of this discipline. Students may work with the Emergency Department physicians to perform suturing or to evaluate patients with potential surgical problems. Any of the surgical Intensive Care Units offer vast learning opportunities. Residents staff these units all day and night and should be available to teach any interested students about ventilator management, hemodynamic management, etc. The MUSC Medical Center is an active place at night and the surgery housestaff is always busy. Students are encouraged to seek out housestaff members and share their nights with them. Students on call will be excused at 8 AM the following morning to comply with AAMC work hour requirements. However, students are expected to return for any small group sessions scheduled on a day after they are on-call as well as for any conferences specific to the service to which they are assigned.

Grading

As with all clinical rotations, grading will be on a Pass, Fail, or Honors basis. In order to pass the rotation, students must successfully pass their clinical evaluation, their written examination, and an OSCE examination. The OSCE examination is given, generally, on the day before the written examination. In order to pass the written examination, students must achieve a score greater than 61 (two standard deviations below the national mean for this examination). Students falling below this standard will be given one opportunity to retake the examination and, if successful, will be considered to have passed the course, assuming all other criteria are met. Students failing the OSCE will also be given a chance to retake the examination and, if passed, will be credited as having passed the course. To pass the clinical portion of the course, students must have an average score on the CPE forms submitted greater than 2.5. In addition, students may not have more than four areas with an average less than 2.0 nor may they have more than one graded area with an average of 1.0. Failure of the clinical portion of the course will result in a failure for the course as a whole and will require retaking of the entire course.

Honors for the written examination will be given to students achieving a score > 80 on the written examination (one standard deviation above the national mean for this examination). Honors for the clinical portion of the course will be given to students whose average score on the CPE form is > 3.75. Overall honors for the entire course will require students to achieve > 3.5 on the clinical portion for the course and a written examination score > than 74.