STUDENT RESPONSIBILITIES FOR GENERAL THORACIC SURGERY
Learning Objectives
1. Acquire knowledge in the following surgically-related problems:
Lung cancer Pleural effusions (benign and malignant) Pneumothorax Esophageal cancer Mediastinal disease 2. Learn to write structured, focused history and physical examinations and progress notes.
3. Learn to efficiently evaluate surgical patients and orally present findings, assessment and plan.
4. Develop Operating Room experience including:
Proper scrubbing technique Participation at the operating table using aseptic technique Correlation of pathological findings with signs and symptoms of disease
5. Acquire patient exposure to refine bedside manner.
6. Refine technical skills including:
Venipuncture Placement and removal of chest tubes Dressing wounds and managing drains Basic suturing Bronchoscopy
General Thoracic Surgery Organization
The General Thoracic Surgery Service is part of the Division of Cardiothoracic Surgery with responsibility for the care of patients with non-cardiac thoracic diseases. The service is composed of a cardiothoracic resident, an R- 3 in general surgery, one or two R-1 in surgery and the thoracic surgery attending staff. The cardiothoracic resident has overall responsibility for the running of the service.
Clinics
Outpatients are seen on Monday morning and Thursdays and all day Tuesday as part of the Multi-disciplinary Thoracic Oncology Program clinic. These clinics are currently held in the Gravely building and at Carolina Pointe II. In addition, Dr. Haithcock sees patient in the weekly lung transplantation clinic in the transplant clinic. Students are expected to attend the MTOP clinic on Tuesdays and other clinics as time permits. They will be assigned patients to see (both new and return) and are expected to completely evaluate the patient and formulate a plan of treatment. This will be discussed directly with one of the general thoracic surgery attending staff. The student will also become familiar with dictating clinic notes into Web CIS.
History and Physical Workups
Students are expected to work-up at least 2 new patients per week either in the clinic or as hospital admissions and to follow those patients though the operating room and post-operative hospital stay. History & Physical workups should adhere to the following format:
Infosource: Chief complaint: (c.c.) HPI PMH (medical, surgical, medications, allergy) SH (smoking, etc) FH ROS (complete, emphasis on pertinent negatives) PE (complete) Database Problem list/Assessment Plan
Progress Notes
Students are expected to write daily progress notes on the patients they are following. These progress notes do not replace the housestaff notes. All progress notes should contain the pertinent subjective (S) and objective (O) findings, as well as a concise assessment (A) and plan (P). The Student Progress Note must be concise and pertinent. Lab data are recorded. Assessment and plans should be discussed with a physician before writing in the chart. Remember the chart is a legal record, and statements should show responsible thinking. A minimum of one Student Progress Note every day until discharge is required. The surgical house staff and Attending physician countersign Student Progress Notes and add comments, corrections, and additions.
The Student Progress Note should follow the format outlined:
Date Student Progress Note PO Day # ______S: Events and active complaints since last rounds O: Vitals signs, I/Os including drains and tubes Physical exam, focused New labs A: Concise list of active issues P: Plan for each active issue
Operating Room Opportunities
Experience in the operating room is a major component of the General Thoracic Surgery rotation. Most all general thoracic surgery operations (open or minimally invasive) are televised for teaching purposes. Each student will have the gross pathology demonstrated to him/her in the operating room on all the patients he/she is following. Student operating room assignments will be decided the day before surgery to give each student ample opportunity to read and prepare for the particular case. It is expected that each student be familiar with each case on which they scrub. Students should make every effort to see the patients pre-op. At a minimum their chart should be reviewed. Although the student following an assigned patient is expected to scrub on that operation, any other students on the service are encouraged to view operations whenever possible during the rotation. . All students are expected to be knowledgeable in operating room conduct. It is the student's responsibility to check on the time of the operative procedure so that he/she may plan his/her activities to be present.
On Call SRG - 2 Students on General Thoracic Surgery will not take over-night in hospital call. They are expected to be present each day until the work of the service for that day is completed. Students will also be required to make morning rounds on 2 weekend mornings during the rotation.
Orders
Students are to learn to write postoperative orders. This is done by observing the housestaff during computerized physician order entry. Proper organization of orders is a high priority. Knowledge of the correct dosage of medicine, proper laboratory tests, and nursing orders is necessary.
Conferences Students on the General Thoracic Surgery Service must attend all formal student lectures and tutorials which are part of the overall surgical rotation. There are several formal teaching sessions that meet on a regularly scheduled basis on General Thoracic Surgery. The students should attend as many of these sessions as possible. Priorities include:
1. MTOP Conference – Tuesdays from 12:00 – 1:30PM in the ground floor conference room of the gravely Building 2. General Surgery Grand Rounds – Wednesday – 7:15-8:15 AM Old Clinic Auditorium 4th floor Old Clinic 3. Thursday teaching conference 7 – 8AM 4. Friday teaching conference 7- 8AM OR conference room, 2nd Floor
Rounds
Early morning Work Rounds are conducted by the housestaff to determine any changes in each patient's condition and make decisions regarding management for the day. Students are responsible for keeping abreast of the clinical condition of their patients and decisions for management. The Cardiothoracic resident supervises afternoon Teaching Rounds with the housestaff and students. Questions and discussion are encouraged. One or more general thoracic surgery attending will make rounds each day with students and house staff. Students should be able to present a brief, but concise synopsis of the patient's problem and progress on rounds on their assigned patients.
Drs. Feins, Haithcock and Veeramachaneni are available to discuss any issues at any time. The General Thoracic Surgery service phone number is 966-3383 and the offices are located on the 3 rd floor of the Burnett-Womack Building.
9/23/2009
SRG - 3