Surgery Clerkship

Surgery is a six-week clerkship during which students are introduced to the care of surgical patients with an emphasis on establishing a diagnosis, learning the pathophysiology of surgical diseases, participating in the treatment of surgical patients, and supporting patients before, during, and after surgery.

Course Learning Objectives:

Medical Knowledge (MK)

(SUR1) Apply knowledge of the pathophysiology, epidemiology, and natural history of diseases in a surgical context. (MK3)
(SUR2) Describe how altered structure and function (pathology and pathophysiology) of the body and organ systems affect surgical care, surgical outcomes and operative risk. (MK4)
(SUR3) Describe the scientific principles underlying diagnostic methods, including laboratory and radiologic testing, and treatment approaches (pharmacologic and non-pharmacologic) that may be applied to major diseases and conditions in a surgical context. (MK5)
(SUR4) Explain how preventive measures, health behaviors and social determinants affect disease, injury and health in surgical patients. (MK7)
(SUR5) Demonstrate knowledge of the scientific method in establishing causation of health and disease, the utility of diagnostic modalities, and the efficacy of therapies in surgical patients. (MK8)

Patient Care (PC)

(SUR6) Obtain essential, accurate, and age-appropriate information about surgical patients through history-taking and physical examination and the use of laboratory data, imaging, and other tests during the preoperative, intraoperative, and postoperative periods. (PC1)
(SUR7) Obtain essential intraoperative and postoperative patient information through hemodynamic monitoring with arterial lines, central lines, transesophageal echocardiogram, etc. (PC 1)
(SUR8) Synthesize relevant patient data to formulate an accurate diagnosis for patients during the multiple phases of surgical care. (PC2)
(SUR9) Evaluate a patient with a presumed surgical diagnosis and develop an appropriate evaluation and management plan utilizing patient information and preferences, evidence-based medicine and clinical judgment. (PC3)
(SUR10) Manage patients during the preoperative, intraoperative, and postoperative phases of care including recognition of common postoperative complications (ex. AKI, respiratory failure, infection, DVT, anemia, malnutrition, nausea/emesis, shock, and wound complications), assessment and management of volume status, management of blood pressure, and management of perioperative pain. (PC3)
(SUR11) Call a consult for surgical patients with a presumed medical diagnosis (ex. infectious, cardiac, renal disease, etc.) and follow up on patient progress and outcomes. (PC4)
(SUR12) Counsel, educate, and partner with patients and families to address acute and chronic ;surgical conditions. (PC5)
(SUR 13) Perform routine procedures for surgical patients. (PC7)
- Perform a preoperative risk assessment including the cardiac, pulmonary, nutritional status of a surgical patient.
- Obtain informed consent.
- Discuss anesthetic options and management with surgical patients including general anesthesia, conscious sedation, regional block, spinal anesthesia, and airway management (ex. intubation, tracheostomy).
- Demonstrate appropriate sterile technique.
- Evaluate and dress a surgical wound including assessment of healing status and infection.
- Discuss appropriate narcotic dosing and multimodal pain management options.

Communication Skills (CS)

(SUR14) Communicate effectively with the patient, patient's family, colleagues and other health care professionals through the use of active listening and appropriate verbal, nonverbal and written skills. (CS1)
(SUR15) Present patient information to the surgical team and consulting teams in a fluid, concise manner. (CS1)
(SUR16) Foster therapeutic and ethically sound relationships with surgical patients through respect, empathy and support of emotions. (CS2)
(SUR17) Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, surgical complications, bad news, disclosure of errors, and other sensitive topics. (CS3)

Professionalism (PR)

(SUR18) Demonstrate honesty, integrity, respect, and compassion in all interactions with patients, peers, faculty, staff, and other health care professionals in all settings including about medical ability and in documentation. (PR1)
(SUR19) Demonstrate ethical, patient-centered decision-making and respect for the confidentiality of patient information in all settings (i.e., clinical, academic, electronic or web-based.) (PR2)
(SUR20) Demonstrate sensitivity and responsiveness to the personhood of the patient inclusive of culture, race, ethnicity, spirituality, gender, sexual orientation, age, physical characteristics, medical condition, disabilities, socioeconomic status, family-context and other aspects of personal and health beliefs, practices and decisions. (PR3)
(SUR21) Demonstrate accountability for academic, patient care and professional responsibilities (PR4)
(SUR22) Demonstrate responsiveness to patient needs that supersedes self-interest. (PR5)

Personal and Professional Development (PD)

(SUR23) Acknowledge personal limitations and mistakes openly and honestly, seek and respond to feedback in a positive way, and demonstrate flexibility and maturity in adjusting one's behavior. (PD1)
(SUR24) Demonstrate strategies for analyzing, identifying and improving personal deficiencies in knowledge and skills by setting learning and improvement goals. (PD2)

Practice-based and Lifelong Learning (PL)

(SUR25)& Demonstrate the ability to retrieve, critically appraise, and integrate current, evidence-based biomedical information into the care of a surgical patient. (PL3)
(SUR26) Apply principles of medical informatics, patient safety and quality improvement to enhance patient care. (PL4)

Systems-based Learning (SL)

(SUR27) Describe health disparities and health care disparities and how they affect surgical patients. (SL4)

Interprofessional Collaboration (IP)

(SUR28) Define the roles and responsibilities of various health professionals in the healthcare team. (IP1)
(SUR29) Work with other health professionals in the operating room and during postoperative care of surgical patients to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust. (IP2)
(SUR30) Communicate effectively and respectfully with other health professionals in a responsive and responsible manner while caring for surgical patients. (IP3)
(SUR31) Collaborate with other health professionals and health care teams to discuss physical therapy and occupational therapy discharge recommendations, discuss medication dosing, and discuss discharge planning. (IP4)

Surgery Clerkship PxDx Log

Procedure	Output or Input
Participate in an open surgical procedure	I
Perform the evaluation of a surgical wound	I/O
Observe a process of informed consent	I
Participate in discussion of appropriate postoperative narcotic dosing	I/O
IPE: Participate in a discharge planning meeting (discuss social work, PT, OT recommendations)	I
Participate in the review of preoperative imaging and/or labs findings with the attending/fellow/chief resident	I/O
Participate in discussion of anesthetic care	I
Participate in the care of a postoperative patient in whose surgery you participated	I
Perform a preoperative risk assessment (ex. frailty, VQI, ACS, NSQIP calculators)	I/O
Perform a history observed by a faculty member	I/O
Participate in a minimally invasive procedure (laparoscopic, thorascopic, endoscopic, endovascular)	I
Participate in the care of patients with the following diagnoses:	Output or Input
Abdominal Pain	I
Tumor/mass	I/O
Nutrition abnormality	I
Perioperative hematologic/infectious disorder (ex. anemia, thrombocytopenia, DVT, leukocytosis, infection	I/O
Pain management: postoperative pain	I/O
Dysvolemia	I
Cardiopulmonary abnormality (ex. arrythmia, COPD, asthma, CHF) impacting surgical care	I/O
Exam	Output or Input
Perform an abdominal exam on a patient	I,O
Perform a physical exam observed by a faculty member	I/O