Third Year Clerkship Surgery

Third Year Clerkship Surgery Orientation: 2011-2012 David Chen, M.D., F.A.C.S. [email protected]

WELCOME TO SURGERY!

I am personally excited to welcome each one of you. Dr. Busuttil, our Chairman of Surgery, and Dean Hiatt, the Vice Chairman and Director of Surgical Education, and the entire Department are delighted you are here.

 We know that most students will not become surgeons but all of you will deal with surgical patients, evaluate surgical problem, require surgical skills, and have patients, friends and loved ones that will eventually need surgery.  It is an exciting field and the most hands on experience that you will have with patients. There is nothing quite like it and I hope that each of you has a meaningful experience on service.  Hopefully, some of you will find it exciting and rewarding enough to become surgeons. For those of you that do, we are here to mentor you, foster your careers, and support you in your training.  The goal of this course is to provide general overview of Surgery- we want to be as relevant to future surgeons as to future primary care physicians, pathologists, dermatologists, etc.  This rotation will be challenging and rigorous but also stimulating, enjoyable, exciting, and fun.

We wish to provide insight into the various disciplines within Surgery  Includes both General Surgery and the Surgical specialties

The genesis of the course as it stands:  Review of past performance indicated that students were not achieving satisfactory standards in physical exam  Concerns as to the breadth of experience and the standardization of exposure  Concerns of student preparedness to begin the Surgery Rotation  Student preconceptions regarding Surgery  Our wish to set the table for the clerkship: to establish the ground rules and outline our expectations.  Hence the current structure: a combined Ambulatory Surgery and General Surgery clerkship with Introduction week

Goals for this week:  Background information  Physical exam modules  Review of the Surgery Clerkship  Organization and Operational Plan

Goals for clerkship:  Broad based knowledge set.  Clinical skill set  Physician skills

Who are we:  We are kinder, gentler people  The preconceptions of Surgery as malignant and surgeons as uncaring is an error  The culture of surgery: Challenging and Rigorous.  Vertically integrated  Truth telling  Small margin for errors  Do’s and don’ts

Logistics (Important)

Web Case Log (http://apps.medsch.ucla.edu/medyear3/pdalog)  Imperative  Required to enter a minimum of 5 cases per week (inpatient & outpatient)  Look at index cases (Core Problems)  Be sure to cover in clinics or in Web based study (listed on ANGEL)

Grades  Clinical Grade  Practical Grade  Shelf exam

Evaluation System  ESS  Site Director Feedback  Weekly Evaluation Card (yellow card) - 1 per week on outpatient

LOD  LOD: 21/180 (11.7%) last year.  Criteria: Excellence in Clinical, Practical, and Shelf Examination  Clinical: Uniformly Excellent to Outstanding Comments with Recommendation for LOD from Residents and Faculty.  Practical: Excellent Performance  Shelf Exam: Consider those that score 1 SD above the mean.

Failure  Failing grades in any of these three components will require remediation or repetition of the rotation depending on the circumstance.

Books  A General Surgery Textbook  No one required text

Resources:  Netter's Surgical Anatomy Review: Robert B. Trelease, Ph.D. http://149.142.173.184/SurgAnat/  Wise MD (18 modules). Recommended to Complete Angel > Surgery Resources > Web based Resources from NYU Login: UCLA Password: UCLA  WebSurg: EU Site of Many Operations and Modules  MD Consult > Books > Khatri’s Operative Anatomy  Access Surgery

Professionalism Behavior

Attire  Look professional (including during orientation  Change into Scrubs for cases  Students on Trauma will usually wears scrubs.  When in doubt, ask your chief resident or attending

Attendance/ Absences  Must be accounted for  Report all absences to the resident on service and Iris

Educational Philosophy: You must be a self learner:  Too much material to cover in didactics  You must read  We will present you with opportunities to see and learn  We provide Faculty and Residents who can expertly answer your questions and clarify issues  We provide an environment where Surgery – in all of its elements is available

We see each other as colleagues:  Professional basis for interaction: Courtesy, consideration, politeness  Respect both directions Zero tolerance policies:  Abuse, disrespect, foul language, and behavior  Untruthfulness, cheating, LYING

Logistics Days Off  One day off per week on inpatient  Weekends off for outpatient  Students do not have the weekend off between inpatient rotations and transitioning to or from ambulatory rotations  Holidays – not all holidays are universally observed; confirm with your resident if there is clinic

Call duties  Varies with site. Check with your resident team and Site Director if call is expected

Wednesday Conferences  Required attendance at morning conference at CHS (excluding students on Harbor inpatient, Harbor Ortho & Urology outpatient)  Cedars Continuity and non-continuity students will stay at Cedars for teleconferencing of student lectures. If services are not available, you are expected at Westwood for conference.

Orientation week:  Introductory lectures and examination modules.

Conclusion  I wish for us to interact as colleagues.  I hope that everyone is exposed to and gets a flavor of Surgery as a culture and field.  I hope that you are challenged.  I hope you have fun.

Iris Mau: Surgery Clerkship Coordinator  TEAM Trauma Module: Friday, February 3 from 1:00 to 5:00 pm at Harbor-UCLA.  Surgery Website – show where resident rotation, schedule, and pagers are listed  ANGEL – Goals and objectives folders