Post on 22-Feb-2020
UICDepartmentofSurgery 1
E n r i c o B e n e d e t t i , M D , F A C S , P r o f e s s o r a n d C h a i r ,
U I C D e p a r t m e n t o f S u r g e r y
A m e l i a B a r t h o l o m e w , M D , M P H , F A C S , S u r g e r y C l e r k s h i p D i r e c t o r
UICDepartmentofSurgeryStudentGuideRevisedJune12,2017toreflectrequirementsofmidtermquiz,newsitedirectoratMtSinai,andpassrate
2017-2018
08
Fall
2 UICDepartmentofSurgery
TableofContents
INTRODUCTION 4
MISSIONSTATEMENT 4
GOALSANDOBJECTIVES 4
1. PATIENTCARE 42. MEDICALKNOWLEDGE 53. PRACTICE-BASEDLEARNINGANDIMPROVEMENT 54.INTERPERSONALANDCOMMUNICATIONSKILLS 65.PROFESSIONALISM 66.SYSTEMS-BASEDPRACTICE 6
REQUIREMENTS 6
1. CASEPRESENTATIONS 72. MINI-CEXEVALUATIONS 73. OPERATIONS 7TABLE1REQUIREDANDRECOMMENDEDOPERATIVECASESASPERTHEFIELDJOURNAL 8OPERATIONSREQUIREDFORPROFICIENCY 8OPERATIONSSTRONGLYRECOMMENDEDFORTHEADVANCEDSTUDENT 8OPERATIONSRECOMMENDEDFORTHEHIGHLYMOTIVATEDSTUDENT 84. LECTURES 85. MID-TERMORALEXAMANDREVIEW 86. SELFDIRECTEDSTUDY 9TABLE2:SUMMARYOFRESOURCES 9ACCESSSURGERY 9THEVIRTUALPATIENT 10TABLE3VIRTUALPATIENT:SPECIFICCASESTOADDRESSPOTENTIALGAPSINSURGICALEXPERIENCE 11WISEMD:COMPLETETHETRAUMAMODULE 117. PROFICIENCIES 11TABLE4LISTOF40REQUIREDPROFICIENCIES(TAKENFROMTHEFIELDJOURNAL) 12
EVALUATION 12
1. EVALUATIVEDATA 122. WEIGHTOFEVALUATIONSANDEXPERIENCEOFEVALUATOR 123. SITEDIRECTORSYNTHESIS,MIDTERM(4WEEK)EVALUATIONANDFINAL(8WEEK)EVALUATION 134. FORMALCLINICALGRADE 135. ABOUTTHESHELFEXAM 13TABLE5SHELFEXAMTOPICS 14TABLE6THIRDYEARCORECLERKSHIPGRADESCALE 16
EXPECTATIONS:THECLINICALEXPERIENCE 16
1.PERI-OPERATIVEANDOPERATIVEEXPECTATIONS 16
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TABLE7ELEMENTSOFTHEPRE-OPERATIVE,OPERATIVE,ANDPOST-OPERATIVENOTES 172.POST-OPERATIVEEXPECTATIONS 18TABLE8ELEMENTSCOMPRISINGTHEDAILYPROGRESSNOTESORTHESOAPNOTE 193.OUTPATIENTSANDCONSULTS:EXPECTATIONSFORNEWPATIENTENCOUNTERSANDFOLLOW-UP 204. AFEWWORDSONMEDICALRECORDS 20TABLE9INFORMATIONNECESSARYTORECORDINACHART 205.ATTENDANCE 206.STUDENTWORKHOURRULES 21
APPENDIX1CLINICALSITESANDCONTACTINFORMATION ERROR!BOOKMARKNOTDEFINED.
APPENDIX2COLLEGEOFMEDICINESTATEMENTONPROFESSIONALISM 24
APPENDIX3DEPARTMENTOFSURGERYSTATEMENTOFEXPECTEDPROFESSIONALPERFORMANCEANDBEHAVIOR 26
APPENDIX4VIRTUALPATIENTSURGERYCASELIST 28
ESOPHAGUS,STOMACHANDDUODENUM 28SMALLINTESTINEANDAPPENDIX 28COLORECTALDISEASE 28BILIARYTRACT 28LIVER 29PANCREAS 29HERNIAS 29SURGICALENDOCRINOLOGY 29TRAUMA 29BURNSANDCRITICALCARE 29SURGICALONCOLOGY 30BREASTDISEASE 30VASCULARSURGERY 30PEDIATRICSURGERY 31UROLOGY 31
APPENDIX5UNIVERSITYOFILLINOISCOLLEGEOFMEDICINEPROCEDURALCOMPETENCIESFORGRADUATINGMEDICALSTUDENTS 32
APPENDIX6ROTATIONSTUDYSTRATEGY 33
IDEALPROCESSOFSTUDY 33RECOMMENDEDTEXT 33HOWTOUSETHISSTUDYSCHEDULE 34
4 UICDepartmentofSurgery
Introduction
Welcome to surgery! It is a pleasure and a privilege to provide an outstandingexperienceinyourmedialschooleducation.Duringtheeightweeksyouwillspendwithus,wehopetoteachyouanumberofexcitingandvaluableskillsforyourfuturepracticeof medicine. Whatever field you choose to pursue, the assessment for surgery, thesurgical interventionand thepost-operative careof yourpatientswillbe inevitable inyourfuturepracticeofmedicineassurgeryintersectswitheverymedicalspecialty.Itiscriticalthatyouimmerseyourselfineverydetailyoucangather,asallaspectsthatyoulearninsurgerywillassistyouincaringforyourpatients.
MissionStatementThepurposeofthethird-yearsurgicalclerkshipistointroduceyoutothelearningexperiencesnecessaryfortheclinicalassessmentandmanagementofpatientsundergoingsurgicalintervention.Throughthisprocessyouwilldevelopafundofsurgicalknowledgeandunderstandingofsurgicalcareprinciples.Youwillparticipatewithsurgeonsintheclinicalassessmentandmanagementofpatientsundergoingvariousstagesofsurgicalintervention.Theseactivitiesincludepatients’preoperative,intraoperative,andpostoperativeevaluationandcareintheoutpatientoffice,inpatientsetting,andoperatingroom,includingdecision-makingprocessesofwhetherornottooperate.Throughtheseexperiencesparticipatingaspartofthesurgicalteam,youwillgainanunderstandingoftheroleofthesurgeonasapartofthemultidisciplinaryteamprovidingcareforthepatient.
GoalsandObjectivesTeaching and learning will focus on the six graduation competencies of patient care,medical knowledge, practice-based learning and improvement, interpersonal andcommunicationskills,professionalism,and fosteringanunderstandingof theconceptsofthesystems-basednatureofhealthcaredelivery.Theimperativeforlifelonglearningwillbeemphasized.
1. PatientCareThe competent graduate must be able to provide patient care that is compassionate,appropriate, and effective for the treatment of health problems and the promotion ofhealth. He/she will be required to construct appropriate management strategies(diagnosticandtherapeutic)forpatientswithcommonhealthcareproblemsthatmaybeemergent,acuteorchronic,acrossthespectrumofdisciplines,whileconsideringcostsforthe patient and others. The graduate must be able to combine knowledge of basicbiomedical,clinical,andcognatesciencestoaccomplishtheabove.Duringthesurgeryclerkshipthestudentwill:1. obtainanaccurateclinicalhistoryfocusedonareaofsurgicalconcern;
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2. performanaccurateclinicalphysicalexamsfocusedonareaofsurgicalconcern;3. presentanddiscusspatientswiththeneedforsurgicalintervention;4. explainvariouscircumstanceswhenanoperationis,andisnot,indicatedandthe
importanceofthetimingoftheintervention;5. discussrationalindicationsfororderingimagingstudies,andlaboratorytests;6. describethelimitedbenefitofnon-operativetherapy.
2. MedicalKnowledgeThefacultyoftheUniversityofIllinoisCollegeofMedicinebelievesthatanystatementofgraduationcompetenciesmustincludemasteryofthenecessarybodyofknowledgewithinthebasic,clinical,andcognatesciencestomanagepatients’health.Moreover,graduatesmustdemonstratetheskillsthatwillenablethemtoutilizetheconceptsandknowledgethatwillbediscoveredthroughouttheyearsfollowingmedicalschool.Duringthesurgeryclerkshipthestudentwill:1. explain the pathophysiology and the prevention strategies of the most common
diseasespresentingforsurgicalintervention;2. describethecourseofthemanagementandperioperativecareofpatients
undergoingsurgicalintervention;3. developtreatmentplansforpatientswithsurgicalillnesses,whileincorporating
knowledgeofculturaldiversityandexperienceintoallpatientcareactivities;4. developdecision-makingskillsintheambulatorysurgicalsetting,withtheultimate
goalofbeingabletoselectbestpracticesfortheambulatorysurgicalpatients;5. discusstherisk/benefitissues(e.g.,thegoalsandrisks,indicationsand
contraindicationsofsurgicaloperations,costconcerns)inthedecisionmakingofsurgicalintervention.
3. Practice-BasedLearningandImprovementThecompetentgraduatemustbeabletostudy,reflect,andevaluatepatientcarepractices,appraise and assimilate scientific evidence, andunderstand their learning needs.He/shemustbecommittedtolifelonglearning.Duringthesurgeryclerkshipthestudentwill:
• demonstrateimprovementonhis/hersurgicalpatienthistorytakingskills;• demonstrateimprovementonhis/herassessmentandphysicalexamination
performanceskills;• applythenecessaryknowledgetoparticipateinthedeliveryofinpatientand
ambulatorysurgicalcaredelivery;• demonstrateandapplytheGraduationCompetenciesinthedailypracticeof
patientcare.
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4.InterpersonalandCommunicationSkills
Thecompetentgraduateprovidescompassionate,effective,culturallysensitivepatientcarewhilerespectingpatientautonomy.
Duringthesurgeryclerkshipthestudentwill:• describetheconceptsof,andassistinobtaininginformedconsentforsurgical
interventions;• communicateeffectivelyandcompassionatelywithpatientsandfamilies.
5.ProfessionalismThe competent graduate approaches medicine with integrity and respect for humandignity. He/shemust demonstrate awareness of and commitment to the principles andresponsibilitiesofmedicalprofessionalism.
Duringthesurgeryclerkshipthestudentwill:1. participateasaneffectivememberofamultidisciplinaryteam,addingvaluetothe
careofthesurgicalpatient;2. actively participate in the clerkship learning activities, as the student knowing
his/herownlearningistheactiveprocessforwhichthestudentisresponsible.3. demonstrate compassion, respect and dignity directed to the patient, family and
colleagues.4. display punctuality, honesty, confidentiality and respect for patients’ privacy
concerns.5. adhere to ethical practices and demonstrate respect and sensitivity to all patient
populations.
6.Systems-BasedPracticeThecompetentgraduatedemonstratesanawarenessofandresponsiveness to the largercontextandsystemsofhealthcare.Duringthesurgeryclerkshipthestudentwill:1. discussknowledgeofexpandedcontextofhealthcarebeyondsurgery2. describeinterdisciplinaryhealthcareservices,techniques,andresourcesforthe
surgicalpatient;3. demonstrateappropriateplanningofinpatientdischargeprotocols,utilizing
interdisciplinaryservicesandresourceswithinthehealthcaresystemforcontinuedpatientcare.
Requirements
PassinggradesontheclinicalportionoftheSurgeryClerkshipandontheNBMEsurgerystandardizedexaminationarerequired.Inordertoearnapassinggradeontheclinical
UICDepartmentofSurgery 7
portion of the clerkship, students must satisfy all learning objectives includingsatisfactorycompletionofthepatientencounterlog,theFIELDJOURNAL,andrequiredprocedures.
1. CasePresentationsThe ability to provide critical information to your colleagues in a clear and succinctmanner is critical in formulating an appropriate plan for the patient. During thisexperienceyoushouldstrivetocompleteaminimumof5presentationseachweek,withtwooftheserepresentinganewpatientorconsultifpossibleforatotalofaminimumof35requiredcasepresentationsforthecourse.Presentationsshouldbemade to a chief/intermediate resident or attending and should include a completehistory,physical exam, interpretationof tests todate, andplanof care.You shouldbeprepared to answer any questions pertinent to the case. The attending or residentshould provide an assessment on the Field Journal and immediately discuss yourperformancewithyou.Failuretocompletethecaserequirementswillresult inanincompletewhichwillneedtobemadeby6weeksfromthedateoftheshelfexamor it will progress to the grade of unsatisfactory. Case participation will beverifiedthroughdiscussionwiththesitedirector.
2. Mini-CEXEvaluationsThe University of Illinois uses the modified Mini-CEX learner Rating Instrument forattendingevaluationofmedicalstudenthistoryandphysical.Youwillberequiredtobeobservedbyanattendingorchiefresidentinyourperformanceofeitherahistoryoraphysical orboth.Theattendingwill provideanassessmenton themini-CEX formandimmediatelydiscussyourperformancewithyou.Thistoolisprovidedtoyoutofurtherenhance feedback by your attendings and to monitor your progress throughout therotation.Pleaseprovideacopyofaminimumoffour(4)mini-CEXevaluationstoyourSiteDirector.
3. OperationsAll the operations you physically scrub in on can be recorded in the Field Journal byaffixingthepatientlabelorlistingpatientinitialsanddateofbirthintothissection.Itisexpectedthattheattendingwilldetermineyour levelofparticipationintheprocedureasmeasuredbyyourpre-operativepreparationforthecase(readingabouttheanatomyanddisease,reviewingthestudies,meetingthepatient),yourassistanceinmovingthepatienttotheroom,settinguptheroomandpreparingthepatientpriortothecase,youractive contribution during the case, ability to answer questions pertinent to theprocedure/disease,andassistanceingettingthepatientsafelytotherecoveryroom.There are certain operations you must participate in, others are recommended, andapproximately35otherscanbeyourchoice(Table1).Pleasemakegreateffortstobeinvolved in the required cases, even if itmeans being the 3rd assistant to the case orparticipating with another service to do so.Aminimum of 35 scrubbed cases arerequiredtopassthecourse;failuretocompletethecaserequirementswillresultinanincompletewhichwillneedtobemadeupby6weeksfromthedateoftheshelfexamor itwillprogress to thegradeof unsatisfactory. Caseparticipationwillbeverifiedbyreviewofoperativerecords.
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Table1RequiredandRecommendedOperativeCasesaspertheFieldJournal
OperationsRequiredforProficiency
OperationsStronglyRecommendedfortheAdvancedStudent
OperationsRecommendedfortheHighlyMotivatedStudent
LaparoscopicCholecystectomy OrthopedicSurgery(any) ThyroidorParathryoidSurgery
Appendectomy UrologicSurgery(any) Liver(any)
BreastBiopsy Intestines,Large(any) Stomach(any)
InguinalHernia Oncology(any) Pancreas(any)
ExploratoryLaparotomy(any) AnorectalSurgery(any) Cardiac(any)
VascularSurgery(any) ENT(any)
Intestines,small(any)
Neurosurgery(any)
PediatricSurgery(any)
PlasticsSurgery(any)
ThoracicSurgery(any)
TraumaSurgery(any)
4. LecturesLectureswillbegiveninroom5175COMRBeveryFriday(seelecturescheduleinUICBlackboard).Attendanceismandatoryforallstudents.Theselecturesandlearningactivitiesareofferedtoenrichyourlearningenvironmentandinmanycases,aredeliveredbyexpertsintheirfieldwhohavebothnationalandinternationalreputationsforthisexpertise.Amidtermquiz,75questions,willbeusedtoassistyouinidentifyingknowledgegaps.ThequizwillbebasedonThe25TopicsEveryMedicalStudentShouldKnow,3questionspertopic.Ascoreof40%orlowerwillinitiatearemediationprogramtoaddressgapsinpreparationfortheendofclerkshipexam.
5. Mid-termOralExamandReviewMid-termoralexamswillbeperformedto
gaugeyourprogressinadditiontothemidtermreview.Eachstudentwillbescheduledforapproximately30-45minutestoreviewtheirexperienceduringtheirrotationandtoassessthestudent’sknowledgebaseontwocasesselectedbythestudent.Pleaseseeinformationonhowtopresenta2minutecase,listedonblackboard.Evaluationwillbedependentonone’sabilitytothoroughlydiscusstheindicationsforsurgeryalternatives,theanatomicalprogression/stepstakenduringtheoperation,andallpossiblecomplicationsthatcouldoccurasaconsequenceofthissurgicalinterventioninadditiontoinfectionandbleeding.Ifoneisdiscussinginfection,oneshouldbecognizantofthetypeofmicrobeassociatedwithinfectionsofthatspecificoperation.Ifoneisdiscussingbleeding,oneshouldbeabletodiscussanatomicallythepotentialsitesof
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bleeding.Additionalcomplicationsshouldalsobediscussedaswellastheiretiologies.Itisexpectedthatdepthofstudywillbeevidentonthepresentationofthesetwocases.
6. SelfDirectedStudyStudentswho scorewell on theNBME exam and earn an outstanding grade generally have areadingplanthattheystickto.Thereistimetoreadifonehasascheduleandoneisdisciplinedtofollowtheschedule.Itisexpectedthatyouprepareforthelectureswiththeassignedreadinglistedforthelecture,listentothelectureandthendotheonlinereviewquestionsfromthetextandfromthePre-TestorLangeQuestionBankinAccessSurgery,orUworld.
Table2:SummaryofResources
There are three additional resources we offer to you to bolster your ability tounderstandcasemanagement.ThesearecalledACCESSSURGERY,TheVirtualPatientandWISEMD.
AccessSurgeryAccessSurgeryTMfromMcGraw-Hillisanintegratedonlineresourcethatprovidesacompendiumoftextbooks,atlases,videos,andquestionbanksformedicalstudents,surgicalresidents,andpracticingsurgeons.Thisonlinesourcewillprovideyouwitheverytextbookreferencerequiredtoinvestigateasurgicaldisease,procedure,complication,orpost-operativemanagementandshouldbereferredtoduringyourdailyworkwithyourpatients.
ClerkshipCorner,housedwithinAccessSurgeryTMisdesignedtoprovideM3stextresources,casescenarios,andquestionandanswersforyoursurgeryrotation.IntheClerkshipCorner,contentisorganizedbothbyCoreTopicsaswellasbyOrganSystems.
ResourcescontainedwithinACCESSSURGERYinclude:
SurgicalVideosSurgicalAnimationsAdaptedfromZollinger'sAtlasofSurgicalOperations,8e
SurgicalTextbooksSchwartz'sPrinciplesofSurgery,9eCURRENTDiagnosis&Treatment:Surgery,13eMaingot'sAbdominalOperations,11e
ACCESSSURGERY Pocketbookreference
Cases Questions
CURRENTDiagnosisandTreatmentSurgery:ThirteenthEdition
SurgeryACompetency-BasedCompanion,byBarryD.Mann,publishedbySaunders,2008
CaseFiles:Surgery(freeonlineviaACCESSSURGERY)
Pre-TestSurgery(freeonlineviaACCESSSURGERY,approximately600questions)
NMSCasebook
U-worldQuestionBank(approximately168questions)
VirtualPatient(onlineresource)
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Trauma,6ePrinciplesofCriticalCare,3eKuerer'sBreastSurgicalOncologyAdultChestSurgeryMcGraw-HillManualColorectalSurgeryMcGraw-HillManualEndocrineSurgeryRoboticSurgeryObesitySurgery:PrinciplesandPracticeCURRENTDiagnosis&TreatmentinOtolaryngology—Head&NeckSurgery,3eSmith'sGeneralUrology,17eCurrentProcedures:Surgery
SurgicalAnatomySkandalakis’SurgicalAnatomy
ClerkshipResourcesCaseFiles:Surgery,3ePreTestSurgery,12eLangeQ&A:Surgery,5e
ExamplesoftargeteduseforACCESSSURGERY1. lookupsymptomordiseaseintheDifferentialDiagnosis(DDx)tool2. searchforvideosorimagesofprocedures3. drugdatabasesearchforindications,dosages,contraindications,anddrugclasses4. AccesstoM3levelinformationtoreviewcasesorquestionsandanswers
HowtofindACCESSSURGERY1.Gotohttp://proxy.cc.uic.edu/login?url=http://www.accesssurgery.com/ andenteryourUICIDinfo2.Alternatively,youmayenterindirectlythroughUIClibrarysite,searchthetermACCESSSURGERY,andaccesstheMcGrawHillServiceACCESSSURGERY.
TheVirtualPatientTheVirtualPatientisawebbasedsurgeryscenarioprogramthatcanbeusedbothasalearning toolandasa rapidreviewof cases for theexam.Theprogram isbroken intosubjectswithseveralcasepresentationspersubject(pleaseseeAppendix2 for listofcases). Each case begins with a history, lists learning objectives, has a section calledimageswhichcanprovidefiguresteachingphysiologyaswellasintra-operativeimagesfrom the operating field, provides well-labeled, color-coded x-ray studies such asultrasounds, and ends with open ended questions with answers tomake certain youfullyunderstandthecaseanditsmanagement.Thisprogramisarapidmethodtoobtaincasereviewpractice inaveryconcentrated fashion.TheURLfor thisutilizesyourUICbluestemidentification.TheURLis:
https://tigger.uic.edu/htbin/bluestem/doc.cgi/com/virtualpatient/
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Table3VirtualPatient:SpecificcasestoaddresspotentialgapsinsurgicalexperienceSurgicalendocrinology cases1-7Trauma cases1-5BurnsandCriticalCare cases1-6SurgicalOncology cases1-5PediatricSurgery cases1-7Urology cases1-4*ASPARTOFSUBJECTREVIEWFOREACHSUBJECTinthereadingschedule,totestyourunderstandingofwhatyouread,movetothequestionsattheendofeachcase.Ifthesecanbeansweredwithease,youhaveunderstoodandsuccessfullyappliedthematerialread;ifnot,reviewthecaseforanotherlevelofreinforcement.
WISEMD:CompletetheTraumaModuleWiseMDisanotherinteractiveonlinetooltolearnsubjectsandcasepresentationsusingamulti-mediaapproach.Topicsarepresentedinseveralformats:lecture,viacartoon,withanimation,andwithvideotoprovideaseriesofperspectivesonthesubject.StudentsarerequiredtocompletetheTraumaModuleduringthisrotation.YouwillneedtoregisterviatheMedUhomepage(www.med-u.org).Atthetoprighthandofthescreen,thereisalink"Register."Clickthatlinkandselecttheoptionthatyouareastudentregisteringthroughasubscribinginstitution.Whenprompted,enteryourUICemailaddresses(Illinoisaddresses--nootheremailaccountswillbeallowedasthisishowyouarerecognizedasenrolledmedicalstudentsatUIC)andotherinformation.Onceyouhit"submit"anemailwillprovideyouwithalinkthatyoumustclickinordertocompleteyourregistration. Onceyouhaveregisteredsuccessfully,youwillhaveaccess.YoucanaccessthecasesanytimeagainfromtheMedUhomepage,butratherthanselecting"Register"fromthetoprighthand,youwillselect"LogintoCases."Foranyadditionalinformation,pleasevisithttp://www.med-u.org/support/logging_in
7. ProficienciesTheability todoprocedures safelywithanexcellentoutcome is the foundationof thesurgical subspecialty. The following procedures are skills that you should have acomfortablegraspofbeforetheendofyourrotation.Inallofyourfuturerotationsandlikelycareers,youwillbeputinasituationwhereoneoftheseskillswillbeneeded.Itisimportantthatyouknowhowtodoitproperlyandsafely.Beaggressiveinrequestingtodotheseproceduresundertheguidanceofsomeoneseniortoyouwhohastheproperexperience.Table4presents the typeand frequencyof theseskills tobedocumentedduring the rotation in yourField Journal. For those studentsunable to accessmedicalchartingduetolocalhospitalpolicy,wehaveincludedtemplatesforpre-operative,post-operative and operative notes for you to complete directly in the field journal.Completion of proficiencies below are required to pass the course. Failure tocomplete thirty (30)proficiencieswill result in an incomplete. Failure to complete30
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proficiencies by 6 weeks from the date of the shelf exam will result in the grade ofunsatisfactory.
Table4Listof40REQUIREDProficiencies(takenfromtheFieldJournal)
EvaluationAnassessmentofthestudent’sclinicalperformancebydirectfacultyobservationandwrittenevaluationandanassessmentofthefundofknowledgebytheNBMEsurgeryexaminationdeterminethefinalgrade.TheGraduationCompetenciesareintegratedintotheclinicalevaluationformsusedbyfacultytoassesstheclinicalperformanceofthestudents.
1. EvaluativeDataEvaluationsarevalidlysubmittedfromresidents,interns,andattendings.Anattendingmayelecttorequestinputfromresidentsandinternsinordertosubmittheattendingevaluation.Anattendingmayprovideanevaluationexclusiveofinputfromresidentsandinterns.Housestaffmaysubmitevaluations.Allarevalidmethodsofevaluation.Aminimumofoneevaluationfromanattendingorchiefresidentfromeveryclinicalrotation/servicethatyouareonduringyourclerkshipisincluded.Inaddition,evaluativedatafromyourperformanceintheFridaylearningactivitieswillbeaddedtothefinalevaluation.
2. WeightofEvaluationsandExperienceofEvaluatorTheweightgiventoanevaluationisbasedontheamountofexposuretothestudent.
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Ifthestudenthasseveralhoursofexposurethisevaluationwillbeconsideredmoreheavilybythesitedirectorthanthosethathavelesshoursofexposure.Theexperienceoftheevaluatorisalsotakenintoaccount.Aninternwithseveralhoursofexposuremaybeequallyorlessweightedthananattendingwithlesshoursofexposurebasedontheattending'smultipleyearsofexperiencewithstudentassessmentandeducation.
3. SiteDirectorsynthesis,Midterm(4week)EvaluationandFinal(8week)EvaluationTheSiteDirectorwilltakeallevaluativedata,weighitasdeemedappropriate,andsynthesizeallevaluationsfromthesiteintoasingleevaluationwhichisthensenttotheClerkshipDirectorforapprovalandformalsubmission.Itistothestudent’sgreatbenefittoreviewthisevaluationwiththeirrespectivesitedirectoratfourweeks(midtermevaluation)andatthecloseoftheclerkship.Thiscarefulreviewwiththesitedirectorshouldsoughtbythestudenttogaininsightonone’sperformance,howitcanbeimproved,andifyouwerestupendous,toreceiveaudaciouscongratulatoryremarkscombinedwithamellifluouslitanyofsupplicationstoembracesurgeryasyourlife'swork.IntheMidtermevaluationperformedat4weeks,youwillalsomeetwiththeclerkshipdirectortodiscussthenumberofcasesandcompetenciesperformedaswellastwocasespreparedfordiscussion.Thecasesselectedarethestudent’schoice(seeabove).
4. FormalClinicalGradeThesiteevaluationgoestotheclerkshipdirectorwhereitisreviewed,finalized,andsubmittedtotheregistrar.Clerkshipattendance,Professionalstandardofbehavior,midtermoralexam,Fridaylearningactivities,andcompletionofthefieldjournalwillbeconsideredintheclinicalgrade.FailuretocompleterequirementssetforthinthestudentmanualandrecordedintheFieldJournalwillleadtoanunsatisfactoryclinicalgrade.Ifthegradeisbetweentwo,anoutstandingcompletionoftheFieldJournalandFridaylearningactivitieswilltipthegradetothehigherone;aproficientcompletionwillretainthelowergrade.ThefinalizedclinicalgradewillbecombinedwiththeShelfExamscoreforthefinalSurgeryClerkshipgrade.Theclinicalportionisweightedtobetwo thirdsofthefinalgradewiththeShelfExambeingtheremainingonethird.
5. AbouttheShelfExamEverystudentwillbeexpectedtopasstheshelfexamasoneoftherequirementsofpassingtheclerkship.ItisanticipatedthatallstudentswillstrivetoachieveanOutstandinggradeontheexamandthiscanbeachievedbydiligentanddailystudyscheduleoverthe8weekrotation.BelowarethetopicsdefinedbytheNBMEprovidingtheweightingofeachtopicfortheexam.PleasereviewthisbreakdownandappropriateyourtimeaccordinglytothesubjectmatterlistedinTable5.
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TheNBMEwebsiteprovidesexamplesoftestquestionsandotherinformationtofamiliarizeyouwiththeexam.TheURLis:http://www.nbme.orgNavigatetoStudentServicesandseektheshelfexamarea.
Table5ShelfExamTopicsTopic Percent
General Principles 1-5 Organ Systems 95-99Immunologic Disorders 1-5Diseases of the Blood and Blood-forming Organs 5-10 Diseases of the Nervous System and Special Senses 5-10Cardiovascular Disorders 10-15Diseases of the Respiratory System 10-15Nutritional and Digestive Disorders 25-30Gynecologic Disorders 5-10Renal, Urinary, and Male Reproductive System 5-10Disorders of Pregnancy, Childbirth, and the Puerperium
1-5
Disorders of the Skin and Subcutaneous Tissues 1-5Diseases of the Musculoskeletal System and Connective Tissue
5-10
Endocrine and Metabolic Disorders 5-10 Physician Tasks Promoting Health and Health Maintenance 1-5Understanding Mechanisms of Disease 20-25Establishing a Diagnosis 45-50Applying Principles of Management 25-306. TheCollegeofMedicinePromotions2011-2012PolicyonSurgeryPerformance
a. TheCollegeofMedicinedefinessixrequiredclerkshipsascore:FamilyMedicine,Medicine,ObstetricsandGynecology,Pediatrics,Psychiatry,andSurgery.Theclinicalperformancecomponentandtheend-of-clerkshipexaminationcomponentmustbepassedindependentlytosatisfyrequirements.
b. Theappropriatesitecommittee(s)andtheCommitteeonStudentPromotionswilladheretothefollowingpolicieswhenreviewingtheperformanceofM3studentswhoaredeficientincoreclerkships.
c. ClinicalRequirements:InitialAttempti. StudentsmayreceiveatemporarygradeofIncompleteinacoreclerkshipiftheyhavenotsatisfiedallrequirementswithintheusual
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timeallotment.Thisgradeisintendedonlyforastudentwhohasaspecificdeficit,butisotherwiseproficient.Theclerkshipdirectorwillprepareanindividualizedstudyplan(ISP)andthestudentwillbegrantedadditionaltimetosatisfytheclerkshiprequirementsatalaterdate.FailuretosatisfyrequirementsaftertheISPwillresultinanUnsatisfactoryclinicalgrade.
ii. Iftheclerkshipdirectorbelievesthattheproblemcouldstillbecorrected,thestudentwouldberequiredtorepeattheentireclerkship.Failureinthesecondattemptatafullclerkshipwouldbegroundsfordismissal.
iii. Studentswhohavehadtorepeattheclinicalexperience(oranypartthereof)willreceiveagradeofProficientiftheysuccessfullycompletethestudyplan.ThesestudentsarenoteligibletoreceiveanAdvancedorOutstandingFinalGrade.
d. FailuretoSatisfyClinicalRequirementsi. StudentswhoarejudgedtobebelowtheacceptablelevelofperformanceinacoreclerkshipbythedepartmentwillreceiveaclinicalgradeofUnsatisfactory.Theymustrepeattheclerkshipinitsentirety.Failureinthesecondattemptatafullclerkshipwouldbegroundsfordismissal.
e. EndofClerkshipExaminationFailurei. Studentswhopasstheclinicalcomponentbutfailthesubjectexaminationwillbeallowedtoretakethesubjectexaminationfollowingaperiodofdirectedstudy.Iftheypasstheretakeexamination,theirrecordswillbeannotated"Passedafterretakeexamination."Iftheydonotpassthesecondattempt,theyfailtheclerkshipandwillreceiveanUnsatisfactorygradeontheirtranscript.
ii. Studentswhohaveanunsatisfactorygradeduetoasubjectexaminationfailurewillbeallowedafinalattempttorepeattheclerkshipinitsentirety,includingtheendoftheclerkshipexamination.Iftheydonotpasstheclerkship(clinicalcomponentandendofclerkshipexamination)theywouldbedismissed.Thegradeearnedfortheclinicalcomponentoftherepeatclerkshipwillbeusedtocalculatethefinalgrade.Theclinicalgradeusedinthecalculationcannotexceedtheclinicalgradeearnedfortheinitialrotation.NotewellthatstudentsmustsatisfyallclerkshiprequirementsatleastattheProficientlevel.ThismayresultinaProficientorAdvanced,dependingonthestudentsperformancefortheclinicalcomponent.StudentswhohavehadtoretakeclerkshipexaminationsarenoteligibletoreceiveanOutstandingFinalGrade.
f. MultipleDeficienciesi. Studentswhoaccumulatemorethanonefailinggradewillbewithdrawnfromfurtherclinicalactivityattheendoftheclerkshiporclinicalactivityinwhichthesecondfailinggradeisreported.Studentsmaynotresumeanyclinicalactivityuntiltheyhaveachievedpassinggradesinallexaminationsandclinicalcomponentsinwhichtheir
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performancewasdeficient.Studentswillbeallowedtoparticipateinnon-clinicalcourses,whileawaitingtheresultsoftheirremedialefforts.
Table6THIRDYEARCORECLERKSHIPGRADESCALEACADEMICYEAR2017-18
ExamScoreConversionto
PointsClinicalPerformanceConversiontoPoints
FinalGradeConversionofTotalScore
0-61=0 Unsatisfactory(U)=0 0-6=U62-64=2 Incomplete(Inc)* 65-72=3 Proficient(PR)=6 8–10=PR73-78=4 Advanced(ADV)=8 11–13=ADV
79orabove=6 Outstanding(O)=10 14–16=0
EXAMPASSLEVELASOFJUNE2017=62THESILVERSCALPELAWARDEEMUSTSCORE85ORHIGHERAND
RECEIVEACLINICALGRADEOFOUTSTANDING*Incompleteisatemporarygradeissueduntilallrequirementsaresatisfied.Thefinalgradeis
computedusingscoresfromlastattempts.
Expectations:TheClinicalExperienceSurgeryisquitedifferentfromotherrotations.Asastudentyouwillbeexpectedtoseeandexamineyourpatients,discussandunderstandtheirtreatmentplan,andwritetheirmedicalprogressnotesallbeforeyougotosurgerysometimebetween7and7:30am.Thismeans,yourdaywillstartveryearly,likelyby5:30or6:00ambutitwillalsoendearlywithnomorethan12hoursexpectedonserviceunlessyouarescrubbedinaparticularlycompellingcasethatyousimplycannottearyourselfawayfrom!
1.Peri-operativeandOperativeExpectations1) acquaintyourselfwiththepatientifpossiblebeforetheyundergoanesthesiaandfamiliarize
yourselfwiththepre-operativenote(seeTable7).2) understandthediagnosticapproachtakentoworkupthepatientandaskquestionsonthe
choiceofthestudies–thisisaparticularlycriticalpart-eachpatientmayhaveslightlydifferentclinicalpresentations.Understandingthedecisionmakingprocessonwhattestswereselectedtoconfirmthediagnosiswillsharpenyourabilitiestorecognizepatternsofpatientpresentationthatrequiresurgicalintervention.Thesepatternswillhelpyoulife-longinprovidingexpertcareforyourpatients.
3) Understandthepurpose/procedureofthesurgery,theanatomyencounteredduringthesurgery,andifyouarereallystrivingfortheoutstanding,understandwhatpotentialanatomicalcomplicationsmightpresentthemselvesduringtheprocedure.Onceagain,thisisagoldenopportunityforyoutoaskquestions.Askabouttheanatomicapproach,askaboutthepost-operativemanagement,askasmanyquestionsasyouneedtosecureagreatunderstandingofwhatyouarewatchingandhowitwillimpactthatpatient’slife.
UICDepartmentofSurgery 17
4) Writetheoperativenote(seeTable7).Asthestudent,partofbeinginvolvedisunderstandingwhathasjusttranspiredintheoperatingroom.Thereisnobettersummarythanthebriefoperativenoterequiredofallsurgicalcasesandprocedures.
Table7ElementsofthePre-Operative,Operative,andPost-operativeNotesElement Pre-OperativeNote OperativeNote Post-OperativeNote1 Pertinenthistory Pre-operative
DiagnosisPatient’smentalstatus-isthepatientalertandorientedtoperson,placeandtimeoristhepatientsomnolentanddifficulttoarouse?Canthepatientmoveallextremitiesspontaneouslyordotheyappearflaccid?
2 Pertinentphysicalfindings
Post-operativeDiagnosis-sometimesadditionaldiagnosesarefoundduringsurgeryandshouldbelistedhere
Vitalsigns-Temperature,Pulse,BloodPressure,CVP,andpulseoxifpresent
3 PertinentDiagnosticEvaluations
Procedure UrineOutputperhour-urineoutputreflectscardiovascularand/orrenalstatuswithlessthan0.5ml/kg/hrrequiringimmediateevaluation
4 IndicationfortheProcedure/pre-operativediagnosis
Anesthetic(generaloralEndotracheal,epidural,Local,spinal,regionalBlock,etc)
ConditionofDressing-isitcleananddryorsoakedwithbloodorotherfluids?
5 Pertinentpre-oplabs,(ieCBC,chemistries,XrayorCT)
Surgeon(thisisnearlyalwaystheattendingunlessotherwisespecified)
TubesandDrains-whataretheoutputsperhour?whatiscomingout-clearfluid,serosanguinousdrainage?Notecolor,amount,andodor
6 Anynotationofspecialpreparations,iebowelprep
Assistants(yes,thismeansyou)
7 BloodComponentsrequestedifany,ieatypeandscreenwassentortypedandcrossedfor2uPRBCs
Findings-thisisacriticalportionofthenoteandshouldbediscussedwiththesurgeonpriortowriting
8 Consent:Aclearstatementshouldbeincludedindicatingnotonlythattheconsenthasbeenobtainedbutalso
EstimatedBloodLoss-thisamountisgenerallyanamountagreeduponbythesurgeonandanesthesiologistand
18 UICDepartmentofSurgery
thattheprocedure,indication,alternativemethodsoftreatment,andriskshavebeendiscussedwiththepatientandthepatientappearstounderstandthem.
criticalfordeterminingpost-operativefluidmanagement
9 FluidandBloodcomponentsadministered-alsocriticalinpost-opmanagement
10 Drainsandtubesinsertedhereyoulisttheurinarycatheter,NGtube,penroseorJPdrain,centralvenouscatheter;basicallyanytubethepatienthas
11 Specimens-anytissueremovedfromthepatientforanyreasonshouldbelistedhere
12 Complications-thissectionshouldbediscussedwiththeattendingpriortowriting
13 Post-operativecondition-wasthepatientextubated,takentothePACUortakenintubatedstraighttotheICU?Anynotableaspectsimpairingthepatient’sabilitytogetupandgohomeshouldbenotedhere-ifdischargedtohome,thisshouldbenotedheretoo.
2.Post-OperativeExpectations1) Writethepost-operativenoteorsignitouttothestudentoncall(seeTable7).Afewhours
aftersurgery,allinpatientsundergoapost-operativecheck.Thischeckincludesanexamandassessmentforpain,bleeding,respiratorydistress,andlife-threateninginfectionandmayormaynotincludelaboratoriessuchasaCBCorchemistries.Apost-operativecheckisextremelyimportanttodoaftersurgeryandcan,insomecases,meanthedifferencebetweenatimelyinterventionoraprecipitouscomplicationormortality.
2) Forthosepatientsthatyouscrubon,itisrecommendedthatyoufollowtheirhospitalcourseandwritedailyprogressnotesonthem(seeTable8).Nothingpunctuatesthepatternofadiseaseanditssurgicaltreatmentmorevividlythanobservingitinrealtime.Yourdailynoteswillchroniclethedisease,itsmitigationorcurewithsurgery,andtheimpactithason
UICDepartmentofSurgery 19
yourpatient.Pleasemakeeveryefforttoundertakethisprocessasitpermitsyoutounderstandthefullspectrumofthedisease.
Table8ElementsComprisingtheDailyProgressNotesortheSOAPnoteElement Heading Description Post-operativeDay#
s/p[nameofprocedure]
Anycaregiverreadingthechartshouldbeabletoopenthenoteofthedayandimmediatelyunderstandwhatsurgerythepatienthadandhowmanydayspost-opthepatientis
Subjective(S)
S commonlyannotatedwithanS:thissectionindicateswhatthepatient’sassessmentoftheirownconditionis-aretheyindiscomfort?Dotheyfeelconfused?Aretheyhungry?etc
Objective(O)
VitalSigns Tmax,Tnow,Pulse,RespRate,BP,Urineoutput,TubeandDrainOutput,BowelMovements-payattentiontotachycardiaasthismaypredictcardiovascularcollapse,impendingrespiratoryfailure,sepsis,orseverepain.Painshoulddiminisheachday;anincreaseinpainisofconcernandsuggestsanewpathology
Exam Everypatientshouldhavea(n)-lungexamtodeterminedegreeofatelectasis/pneumonia,-extremityexamtoobservesignsoffluidstatus/deepveinthrombosis-cardiacexamtodetermineanynewfindings(ie,cardiacfailure,newonsetmurmer),-skinexamincludingthewound,tube/drainsites,andIVsitesforredness/drainage/infection,-otherpartsoftheexamspecifictotheprocedure:abdomen-isthereareturnofbowelsounds,istheabdomendistended,tympaniticorflatandsoft?
Labs listlabresultsthatarenewandthatwillbeusedtoformthetreatmentplan
AssessmentandPlan
Problembased Herelistallproblems/diagnosesandtheplanforeach.Examplescouldinclude:-pulmonaryhygiene-patientcontinuestohaveatelectasis,continuerespiratoryspirometry;encourageambulationtoday-cardiac-patientwithnewonsetlowerextremitypedaledemaandS3hearttonessuggestingsomeevidenceofcardiacfailure;plantotreatwithadiuretic,Lasix20mg-wound-incisionishealingwellwithnosignsofinfection;plantoremovestaplesin3days-nutrition-patienthaspassedgasandhasevidenceofreturnofbowelfunction.Willadvancetolowsaltgeneraldiet-musculoskeletal-patienthasbecomeprofoundlyweakinthelowerextremitiesandisunabletoambulatewithoutassistance.Willconsultphysicaltherapytofacilitateambulation-infection-therearesignsofathrombophlebitisfromtheleftarmIVsite.Thepatientwillbetreatedwithcefazolinforfivedays.-endocrine-bloodsugarcontinuestoexceed200,willincreasetheoralhypoglycemicdoseandcheckbloodglucosetwicedailytodetermineeffect
20 UICDepartmentofSurgery
3.OutpatientsandConsults:ExpectationsforNewPatientEncountersandFollow-upTotrulyappreciatethefullspectrumofthediseaseanditssurgicaltreatment,pleasemakeeveryefforttoattendoutpatientclinicand/ordoctorofficehourswhenyouarenotassignedtotheoperatingroomoronthewardsprovidinginpatientcare.Thisportionoftheexperience,providestheinterfacebetweenthesurgicalreferralfromotherphysiciansandthediagnosticstrategyatthepre-operativeendandatthepost-operativeend,providesinsightonsurgicalefficacy,rateofconvalescence,post-operativecomplications,andoverallprognosis.Trytospendatleastonedayperweekeitherinclinicorseeingnewconsultsontheinpatientside.Bothwillprovideexceptionalexperiencesinsurgicalassessmentanddecisionmakingskills.
4. AFewWordsonMedicalRecordsThemedicalrecordisamedicalandlegaldocumentandrequiresspecificannotations(Table9).Accuraterecordkeepingisparamount.Entriesshouldbelegibleandmadeinblackinkifhandwritten.Attendingphysiciansreviewandcountersignallstudentnotes.Ifyoumakeanerror,donotblackoutanywords--putasinglelinethroughandinitialthechange.Donotgobackandfillinblankslater.Ifsomeinformationismissing,makeaseparate,briefnotelaterinthechartdatingandtimingitinrealtimeasanaddendum.
Table9InformationNecessarytoRecordinaChart1.Dateofentry2.Timeofentry3.Typeofentry(e.g.,admittingHandP,progressnote,operativenote)4.Legiblesignatureorsignatureandlegibleprintedname5.Statusofstudent(e.g.,M-3,M-4,resident,etc.)
5.AttendanceAttendanceateducationalsessionsismandatory.Developmentofastrongsenseofcommitmentandresponsibilityismostimportantinthestudent’sdevelopment.However,duringtheM-3Clerkship,youarenotyettheresponsiblephysician.Yourprioritiesareasfollows:
1. Clerkshipactivitiesinvolvingallstudents,atallsites(i.e.,corelectureseries):Attendanceismandatory.2. Clerkshipactivitiesinvolvingallstudentsatyourassignedsite(i.e.,seminars,conferences).
3. Serviceroundsandteachingsessions,outpatient/officeattendance,operatingroomduties.
4. “SCUT”workforserviceand/orotherpatients--timepermitting.
UICPolicyonAbsencesduringtheClerkship:Absencesfromclerkshipscanimpedestudents’abilitytoachievethelearninggoalsand
UICDepartmentofSurgery 21
objectivesoftheclerkship.Studentsshouldmakeeveryefforttoavoidabsences.Acceptablereasonsformissingclerkshiptimeincludeinterviewingforresidency,illness,representingtheuniversityatprofessionalmeetings,andfamilyemergencies.Appropriatedocumentationwillbeexpected.Fornon-acuteabsences,studentsaretogetapprovalfromtheclerkshipdirectoratleastone(1)weekinadvance.Whenaone-weekadvancednoticeisnotpossible(suchasillnessoremergency),thestudentshouldnotifytheclerkshipdirectorassoonaspossible. Duringaneightortwelveweekclerkship,studentsmaymissuptothree(3)daysofrequestedapprovedabsencewithouthavingtomake-upmissedtime.Ifthestudentmissesmorethanthreedaysduetoarequestedapprovedabsenceoranylengthoftimeduetoanunapprovedabsence,theclerkshipdirectorwilldetermineifandhowmuchtimethestudentneedstomakeupandinwhatmanner. IfaClerkshipDirectorandastudentareunabletocometoanagreementaboutanabsence,theDeanforAcademicAffairswillmediatethesituation.
6.StudentWorkHourRulesa. themaximumnumberofrequiredhoursatclinicalsites(hospital,clinic,
nursinghome,etc)shallnotexceed80hoursperweek.b. Studentsmusthaveanaverageofone24hourperiodeachweekfreeof
clinicalresponsibilitiesincludinglectures,seminars,clinicduties,roundsc. NostudentshouldbeexpectedtoreportbeforetheResidentteamorbe
forced/coercedtoremainafter6:00PMatnight,unlessoncall.d. Studentsshouldbeassignedtoanightsurgicalcallschedule,sothatcommon
emergencysurgicalproblemscanbedealtwithbythestudentfunctioningasanintegralpartofthehealthcaredeliveryteam.Thefrequencywithwhichthestudentisoncallshouldbefrequentenoughtoprovideampleexperiencewithsurgicalemergenciesforthestudentduringtheclerkship.
e. Itisrecommendedthatnightcallbetakenanaverageofeveryfourthdayoverthedurationoftheexperience.
f. Thereshouldbenorequiredconsecutiveovernightcall.g. Nightcallshouldnotberequiredthedaybeforetheendoftheclerkship
examinationoronThursday,thedaybeforeFridaylectures.
Priortoreturningfromanabsence,youareexpectedtoreporttoAcademicAffairstodocumentyourabsenceandtimeofreturn.Failuretodosowillleadtoanunsatisfactorycompletionofthisclerkship.
22 UICDepartmentofSurgery
Appendix1ClinicalSitesandContactInformationHospital Address SiteDirector SiteCoordinatorAdvocateChristMedicalCenter
4440W.95thStOakLawn,IL60453708.684.8000
BryceBardezbanian,MD708.425.6370bryce.bardezbanian@advocatehealth.com
ColletteKotarski708.684.5684colletta.plonis-kotarski@Advocatehealth.comCherieOvercastGMEcoordinator708.684.5450Cherri.overcast@advocatehealth.com
AdvocateIllinoisMasonicMedCenter
3000N.Halsted,Suite711Chicago,IL60657Office:773.296.3390
NikolaosDallas,MD773.296.3390Nikolaos.Dallas@advocatehealth.com
MariaGarcia773.296.5945maria-i.garcia@advocatehealth.com
EloisaBuenaventura773-296-7465Eloisa.buenaventura@advocatehealth.com
AdvocateLutheranGeneralHospital
1775DempsterParkRidge,IL60668847.723.7200
SanjaNikolich,MD sanja.nikolich@ advocatehealth.com
MarisolHernandez-Martinez847-723-6464Marisol.hernandez-martinez@Advocatehealth.com
JesseBrownVAHospital
820S.DamenAve.,MP112Chicago,IL60612312.569.8387
StuartH.Lipnick,MD312.569.6818stuart.lipnick@va.gov
AngieOwens312.569.7870or7875angielene.owens@med.va.gov
MercyHospitalandMedicalCenter
2525SouthMichiganAvenueChicago,IL60616312.567.2211
AndyPerrott,MDaperrott@mercy-chicago.org
SaundryaLomax312.567.2074slomax@mercy-chicago.org
St.FrancisHospitalofEvanston
355RidgeAvenue
Evanston,IL60202847.316.4000
MichaelPrendergast,MD
847.869.0522mprendergast01@hotmail.com
CatherineClark,CPC847-316-3111cclark1@presencehealth.org
St. 2900NorthLake MarkConnolly,MD KathyMcGaghie
UICDepartmentofSurgery 23
JosephHospital
ShoreDriveChicago,IL60657773.665.3000
mconnolly@reshealthcare.org
773.665.6237KMcGaghie@reshealthcare.org
StrogerHospitalofCookCounty
1901W.Harrison,Chicago,IL60612312.864.6000
ThomasKomar,MDPgr:312.333.0254tmkomar@msn.com
MariaRodriguez312.864.3202Mrodriguez3@cookcountyhhs.org
UniversityofIllinoisatChicago
840S.WoodSt.,518-EChicago,IL60612312.996.7000
SiteDirectorScottZiporin,MD,FACSCell314.369.1380ziporins@uic.eduCo-SiteDirectorFrancescoBianco,MDCell312.636.3591
biancofm@uic.edu
TriciaHarvatResearchAssociate312.996.9609babcockt@uic.edu
Mt.SinaiHospital
1500SouthCaliforniaAve.RoomOS351–MainHospitalChicago,IL60608773.542.2000
SiteDirectorThomasDekojThomas.Dekoj@sinai.org
SusieAvila773.257.6777avis@sinai.orgResidencyCoordinatorVanessaSalazar773-257-6464Vanessa.salazar@sinai.org
WeissMemorialHospital
4646N.MarineDrive60640CElevator,7thFloorChicago,IL773.564.5187
BernardoDuarte,MDdrduarte24@gmail.comCell: 630. 247.1160
EricaDelgadoOffice (Weiss): 773.564.5187erica.delgado20@gmail.com
ClerkshipDirectorAmeliaBartholomew,MD,MPH,FACS909SouthWolcott,Suite5060(lab),Room5113(office)celltelephone312.617.8720emailambart@uic.eduordiveris@mac.com
AssistantDirectorRobertArensman,MDCelltelephone773.919.6064Pager773.514.3839
rarensman@hotmail.com
24 UICDepartmentofSurgery
Appendix2CollegeofMedicineStatementonProfessionalismMedicineisaprofessionthatrequiresthemasteryofalargebodyofknowledgeandtheacquisitionofclinicalskills,aswellashighstandardsofbehaviorandappropriateattitudeswithinandoutsidetheacademicsetting.Inadditiontofulfillingallacademicrequirements,studentsarerequiredtodisplayattitudes,personalcharacteristics,andbehaviorsconsistentwithacceptedstandardsofprofessionalconductattheUniversityofIllinoisCollegeofMedicine,andfurtherdefinedbyotherprofessionaldocumentsinmedicine1.StudentswhofailtodosowillbedismissedfromtheCollegeofMedicine.Thefacultybelievesthatcertaindimensionsofprofessionalismmaybeamenabletoremediation,inwhichcasestudentswouldberequiredtocompletesatisfactorilyadditionalactivities/experiencesspecifiedbytheappropriatesitecommitteeandapprovedbytheCollegeCommitteeonStudentPromotions.Satisfactorycompletionofadditionalactivities/experiencesmayresultinadelayinthestudent'sprogresstowardgraduation.Alternately,theappropriatesiteadministrativeofficermayopttopreferdisciplinarychargesthroughtheSenateCommitteeonStudentDiscipline.Itisincumbentuponanystudentwhorecognizeshe/sheisinjeopardyforanyreasontoseektheadviceoftheOfficeofStudentAffairs.Thefollowingpersonalcharacteristicsandattitudesinclude,butarenotlimitedto,thoseobserved and evaluated throughout themedical curriculum. Students are expected todemonstratethesecharacteristics,bothintheiracademicandpersonalpursuits.Integrity: Displays honesty in all situations and interactions; is able to identifyinformationthatisconfidentialandmaintainitsconfidentiality.Tolerance:Demonstratesabilitytoacceptpeopleandsituations.Acknowledgeshis/herbiases and does not allow them to affect patient care or contribute to threatening orharassinginteractionswithothers.Interpersonal relationships:Provides support and is empathetic in interactionswithpeers, patients, and their families. Interacts effectively with "difficult individuals."Demonstrates respect for and complements the roles of other professionals. Iscooperativeandearnsrespect.Initiative: Independently identifies tasks to be performed and completes themsatisfactorily. Performs duties promptly and efficiently. Is willing to spend additionaltimeandtoassumenewresponsibilities.Recognizeswhenhelpisrequiredandwhentoaskforguidance.ProvidesaccuratecontactinformationtoCOMofficialsandmaintainscommunication with the COM whether actively enrolled or on leave. Ensures thatimmunizationsarecurrent.Dependability: Completes tasks promptly and well. Arrives on time and activelyparticipatesinclinicalanddidacticactivities.Followsthroughandisreliable.RespondspromptlytoCOMofficials.
UICDepartmentofSurgery 25
Attitudes: Is actively concerned about others. Maintains a positive outlook towardothersand towardassigned tasks.Recognizesandadmitsmistakes. Seeksandacceptsfeedbackandusesittoimproveperformance.Functionunder stress:Maintainsprofessional composure and exhibits goodpersonaland clinical judgment in stressful situations. Identifies unprofessional conduct whilerecognizingthe importanceofmaintainingprofessionalbehavior intheclinicalsetting,inspiteofinappropriateactiononthepartofothers.Appearance:Displaysappropriateprofessionalappearanceandisappropriatelygroomed.1MedicalProfessionalismProject:ThePhysicianCharter.TheAmericanBoardofInternalMedicineFoundation.http://www.abimfoundation.org/AMACodeofMedicalEthics.TheCouncilonEthicalandJudicialAffairs(CEJA).http://www.ama-assn.org/
26 UICDepartmentofSurgery
Appendix3DepartmentofSurgeryStatementofExpectedProfessionalPerformanceandBehaviorAstandardofprofessionalperformancewhichreflectscertainethicalvaluesandattitudesisexpectedofphysiciansbysociety,byco-workers,byphysiciansthemselves,bythisfaculty,andcertainlybypatients.Theclerkshipexperienceprovidesanopportunityforthemedicalstudenttodevelopandtodemonstratethesevaluesandattitudes.Itisexpectedthatsuchbehaviorwillbeexhibitedinthestudent’sperformanceandwillbeassessedthroughouttheclerkship.Violationsofthesestandardsofbehaviorandresponsetocounselingwillbenotedandincorporatedintothestudent’srecord.Theserecordsmayplayaroleinthefinalevaluationofthestudent’sperformanceandthegradeassignment.Theyalsomaybeusedforthepurposeofdeterminingifremedialworkisneeded,includingrepetitionofapartofortheentireclerkship.Excellenceinperformanceandbehaviormaypositivelyaffectastudent’sfinalevaluationandassignedgrade.Thus,weexpectthefollowingfromourstudents:1. Respectandempathyforthedignityofeverypatientandco-workerregardlessof
religion,race,life-style,genderorpsycho-socio-economicstatus.2. Respectforpatients’rightstoprivacyandconfidentialityinprivateandprofessional
discussions.3. Recognitionoftherightsofpatientsandtheirfamiliestobeadequatelyinformed
abouttheirillness,thegoalsoftreatmentandthepotentialbenefits,risks,andcomplications.(Itisnottheresponsibilityofthestudenttoactuallyobtaintheinformedconsent.)
4. Demonstrationofefforttoimproveskillsincommunicatingwithpatientsandfamilies.
5. Skillincommunicatingwithandworkingwithalltheothermembersofthehealthcareteam,includingpeers.
6. Respectforandtheabilitytoworkharmoniouslywithotheralliedhealthcarepersonnel.
7. Recognitionofanddemonstrationoftheimportanceofconstantself-assessmentandindependentlearning.
8. Abilitytorespondpositivelyandconstructivelytocriticism,constructivefeedback,andevaluationofone’sperformance.
9. Abilitytodemonstrateself-confidenceanddecisiveness.10. Honestyandintegrity.11. Responsibility,reliability,andconscientiousness.12. Appropriateprofessionaldeportmentanddress.
Thefollowingwillberegardedasunacceptableandleadtofailureoftheclerkship:1. Abreachofanyoftheaboveprinciplesofbehavior.2. Failuretorespectapatient’srightsanddignity.
UICDepartmentofSurgery 27
3. Failuretorespecttheprivate,political,and/orreligiousbeliefsofthepatientandone’sco-workers.
4. Deliberatebreachofpatientprivacyorconfidentiality.5. Sexualimproprietywithapatient.6. Deliberatebreachofhospitalpolicies.7. Removalofmedicalrecordsfromthehospital.8. Falsificationofmedicalrecords9. Misrepresentationofone’sroleasastudentinthecareofthepatient.10. Academicdishonestyorplagiarism.11. Cheatingonanexamination.12. Lyinganddishonesty.13. Beingundertheinfluenceofdrugsoralcohol.14. Theftofdrugsorcommissionofanyfelony.15. Failuretoattend,participateandadequatelyprepareforscheduledclerkship
activities.(Ifattendanceisnotpossible,thestudentmustprovidethedepartmentwithajustifiablereason.)
16. Failuretobeavailablewhileoncallwithoutmakingsuitablearrangementsforcoverage.
17. Persistentexcusesfornon-performanceorfailuretocompleterequiredcurricularassignments.
18. Displayofpoorjudgmentsuchas:a. Administrationofanydrugtoapatientwithout(written)authorizationtodo
sofromanattendingphysicianorstaffnurse.b. Performanceofapatientprocedurewithoutspecificinstructionstodofroma
physicianorstaffnurse.c. Failuretoreportanimportantclinicalfindingorchangeinapatient’s
condition.19. Anyotherconductunbecomingorinappropriateofahealthcareprofessional.
28 UICDepartmentofSurgery
Appendix4VirtualPatientSurgeryCaseList
Esophagus,StomachandDuodenumCase#1-A40yearoldmanwithrefluxsymptoms Case#2-A28yearoldwithacuteupperabdominalpain Case#3-A62yearoldwithepigastricpain Case#4-A70yearoldwithepigastricpainandweightloss Case#5-A65yearoldwithhematemesis Case#6-A59yearoldwithdifficultyswallowing Case#7-A42yearoldwomanpresentswithdysphagia Case#8-A60yearoldwomanpresentedwithdysphagia
SmallIntestineandAppendixCase#1-A21yearoldwithacuteRLQpain Case#2-A30yearoldwithsuspectedacuteappendicitis Case#3-A27yearoldwithmonthsofRLQpain Case#4-A61yearoldwithcrampymid-abdominalpain Case#5-A90yearoldwithabdominalpainandvomiting Case#6-A64yearoldwithsepsisandabdominaldistension Case#7-A67yearoldwithvomitingandabdominalbloating Case#8-A55yearoldmanwithwounddrainage6dayspostop Case#9-A30yearoldmanpresentedwithgeneralizedabdominalpain
ColorectalDiseaseCase#1-A50yearoldwithpositivestoolguaiac Case#2-A32yearoldwithbloodydiarrhea Case#3-A75yearoldwithlowerabdominalpainanddistension Case#4-A62yearoldwithLLQpain Case#5-Ahealthy33yearoldwithrectalbleeding Case#6-A34yearoldwithpainonbowelmovements Case#7-A70yearoldfemalewithpassingbrightredbloodperrectum Case#8-A55yearoldmalewith3monthsrectalbleeding Case#9-28yearoldmalepresentswithpurulentdrainage
BiliaryTractCase#1-A40yearoldlady,withR-sidedabdominalpain Case#2-A40yearoldwomanwithepigastricpainandfever Case#3-A43yearoldladywithRUQpain Case#4-Anelderlywomanwithvomitingandabdominaldistension Case#5-A50yearoldwomanwithabdominaldiscomfortaftercholecystectomy Case#6-A69yearoldwomanpresentswithvagueintermittentrightupperquadrantpain
UICDepartmentofSurgery 29
LiverCase#1-A60yearoldwithonemonthofvagueepigastricpain Case#2-A38yearoldwomanwithdullRUQpain Case#3-A35yearoldAsianmalewithweaknessandweightloss Case#4-A65yearoldwithweightlossandanorexia Case#5-A45yearoldwithprogressiveabdominaldistension
PancreasCase#1-A42yearoldwithepigastricpain Case#2-A56yearoldwithabdominalpain Case#3-A45yearoldfemalewithacysticmassonaCTscan
Case#4-A75yearoldladypresentswithjaundice Case#5-A45yearoldwithconfusionandweightgain Case#6-A47yearoldmanadmittedforacutepancreatitis
HerniasCase#1-A17yearoldwithabulgeinhisRgroin Case#2-A35yearoldladywithabulgeinthelowerabdomen
Case#3-A15montholdbabywitha2cmprotrusionattheumbilicus
SurgicalEndocrinologyCase#1-A32yearoldwomanwithathyroidnodule Case#2-A30yearoldwomanwithpalpitationsandweightloss
Case#3-A45yearoldwomanwithanteriorneckswelling Case#4-A60yearoldwithhypercalcemia Case#5-A35yearoldwithrecentonsetofhypertension Case#6-A45yearoldwithanadrenalmassonCT Case#7-38yearoldmalewithlateralneckmass
TraumaCase#1-A34yearoldshotintheLupperchest Case#2-An80yearoldwithconfusionafteranMVC Case#3-A45yearoldwithchestpainafteranMVA Case#4-A20yearoldshotintheabdomen Case#5-A21yearoldstabbedintheLanteriorneck
BurnsandCriticalCareCase#1-A53yearoldwithburnsofherface,neckand
30 UICDepartmentofSurgery
extremitiesCase#2-A21yearoldwithanelectricshock Case#3-A62yearolddeterioratingpostoperatively Case#4-A28yearoldwithseveretrauma Case#5-A28yearoldmansustainedagunshotwound Case#6-A52yearoldmanpresentswithahistoryofmildtrauma
SurgicalOncologyCase#1-A32yearoldwithalesiononherlowerRleg Case#2-A24yearoldwithamassinhisRthigh Case#3-A28yearoldwithenlargedcervicalnodes Case#4-A35yearoldwithlymphadenopathyandanabdominalmass
Case#5-A52yearoldwithprogressiveswellingoftheabdomen.
BreastDiseaseCase#1-A25yearoldwomanwithaRbreastmass Case#2-A45yearoldwomanwithanippledischarge Case#3-A35yearoldwomanwithaswollen,red,tenderLbreast.
Case#4-A55yearoldwomanwithanabnormalmammogram
Case#5-A48yearoldwomanwithaLbreastlump Case#6-50yearoldfemalewiththickeningintherightbreast
Case#7-A51yearoldwomanpresentedwithflakingofthenipple.
VascularSurgeryCase#1-A58yearoldwithaswollenleg Case#2-A54yearoldwithchestpainpostoperatively Case#3-A65yearoldwithapulsatileabdominalmass Case#4-A75yearoldwithacuteabdominalandbackpain Case#5-A64yearoldwithprogressiveLlegpain Case#6-A75yearoldwithbilaterallegcramping Case#7-A55yearoldwithacuteRlegandfootpain Case#8-A72yearoldwithintermittentLeyevisualchanges Case#9-A62year-oldmanwithpainandswellingoffoot Case#10-64yearoldfemalewithabdominalpainfor3hours.
Case#11-A48yearoldwomanpresentedwithedemaoftheleftlowerleg
UICDepartmentofSurgery 31
PediatricSurgeryCase#1-A6montholdwithacuteintermittentabdominalpain
Case#2-Anewbornwithexcessivedrooling Case#3-A4weekoldmalewithprojectilevomiting Case#4-Amaleinfantisbroughttotheemergencyroom Case#5-A3yearoldchildpresentswithswellingoftheabdomen
Case#6-Aoneweekoldinfantpresentswithabdominaldistension
Case#7-Amaleinfantwasdeliverednormallyatterm
UrologyCase#1-A32yearoldwithsevererightsidedabdominalpain
Case#2-A71yearoldwithurinaryfrequencyandstrainingtourinate
Case#3-A68yearoldwithintermittenthematuriaanddysuria
Case#4-A64yearoldwithelevatedprostatespecificantigen(PSA)value
32 UICDepartmentofSurgery
Appendix5UniversityofIllinoisCollegeofMedicineProceduralCompetenciesforGraduatingMedicalStudents1. Arterialpuncture12. Demonstrateproperuseofaninhaler3. EKGleadplacement14.Injection:intradermal5.Injection:intramuscular6.Injection:subcutaneous7.InsertingaFoleycatheter,malepatient8.InsertingaFoleycatheter,femalepatient9.Insertinganintravenouscatheter10.Insertinganasogastrictube111.Knowandperformuniversalprecautions12.Lumbarpuncture113.Manageanairway,includingendotrachealintubation114.Skinsuturing/removalofsutures15.Steriletechnique(Scrub,gown,glove),drape16.Venipuncture
UICDepartmentofSurgery 33
Appendix6RotationStudyStrategyIDEALPROCESSOFSTUDY
o Langechapterinyourpocket;QBANKquestionsathomeasthecomprehensive
foundationofsurgicalknowledgeforM3Clerkshipo Lecturesservetoreinforcereadingmaterialandtoprovidemanagementstrategieso CaseFilestesttheapplicationofknowledgethroughpatientmanagement
o Alternativecasemanagementresourcesorsupplements:VirtualPatient,WISEMDo ACCESSSURGERYonlinetextsandsurgicalatlasesatthehospitalto
o Readondiseasecourse,diagnosticmeasuresandmanagemento ReviewSurgicalprocedureo Readonpost-opcourse,complications
o Week7/8shouldbereviewwithquestionbanksofyourchoice
RecommendedTextCURRENTDiagnosisandTreatmentSurgery:ThirteenthEdition(LANGECURRENTSeries) Thesearetherecommendedtopicsthatyoushouldreadpriortothecorrespondinglecturefortheweek.
Topic Number
Chapter number
Topic
1 Chapter 1 Approach to the Surgical Patient 2 Chapter 2 Training, Communication, Professionalism, and
Systems-based Practice3 Chapter 3 Preoperative Care4 Chapter 4 Postoperative Care5 Chapter 5 Postoperative Complications6 Chapter 6 Wound Healing7 Chapter 8 Inflammation, Infection, & Antimicrobial Therapy8 Chapter 9 Fluid & Electrolyte Management9 Chapter 10 Surgical Metabolism & Nutrition10 Chapter 11 Anesthesia(optional)11 Chapter 12 Shock & Acute Pulmonary Failure in Surgical Patients12 Chapter 13 Management of the Injured Patient13 Chapter 14 Burns & Other Thermal Injuries14 Chapter 15 Otolaryngology—Head & Neck Surgery15 Chapter 16 Thyroid & Parathyroid16 Chapter 17 Breast Disorders17 Chapter 18 Thoracic Wall, Pleura, Mediastinum, & Lung18 Chapter The Heart: I. Surgical Treatment
34 UICDepartmentofSurgery
19.1 19 Chapter
19.11 The Heart: II. Congenital Heart Disease
20 Chapter 20 Esophagus & Diaphragm21 Chapter 21 The Acute Abdomen22 Chapter 22 Peritoneal Cavity23 Chapter 23 Stomach & Duodenum24 Chapter 24 Liver & Portal Venous System25 Chapter 25 Biliary Tract26 Chapter 26 Pancreas27 Chapter 27 Spleen28 Chapter 28 Appendix29 Chapter 29 Small Intestine30 Chapter 30 Large Intestine31 Chapter 31 Anorectum32 Chapter 32 Hernias & Other Lesions of Abdominal Wall33 Chapter 33 Adrenals34 Chapter 34 Arteries35 Chapter 35 Veins & Lymphatics36 Chapter 36 Neurosurgery37 Chapter 38 Urology38 Chapter 40 Orthopedic Surgery39 Chapter 42 Hand Surgery40 Chapter 43 Pediatric Surgery41 Chapter 44 Oncology42 Chapter 45 Organ Transplantation
Howtousethisstudyschedule1) Purchasethetextandripoutchaptersrequiredperweek.OntheSundayofthestartofthe
week,readonlytheboldtypeofeachchapter(onlyheadersofeachsubject).Thiswillreinforcecategoriesforyoutoputknowledgeinto.Thencarrythechaptersaroundwithyouinyourpocketandmakeyourgoaltoreadthechapterbytheendoftheday,ieachapteraday.Thisactionwillfacilitateyourabilitytoreadonthegowithouthavingtocarrythefulltextwithyou.Writeinthemargins,highlight,dowhateverisnecessarytoreadandassimilatethematerial.
2) Youareexpectedtoread7chaptersperweekonaverage;pleasescheduleyourtimeaccordinglytocompletethesechaptersweekly.Eachchapterisbetween15-30pageslong;planonreadingapproximately80-100pagesperweekor14-17pagesperday,6daysperweek.Thistranslatestoanhourorlessperdayofreadingwhichcanbeaccomplishedinfour15-minutepocketsduringthedaywhenyouarewaitingforaresult,waitingforaresidentorattending,waitingforfeedback,orwaitingforyourcoffee.Carvingoutfour15-minutepocketsisanimportantlessontolearn.Whenyoubecomeapracticingphysician,youareexpectedtocontinueyourlearningandtimebecomesmoreandmorescarceasoneprogressesinone’scareer.Gettingtoknowthetrickofhowtocarveouttimefromseeminglynotimeatallisanimportantskillyoumustmasterduringthisrotation.
3) OnFridaysorSaturdaysafterthelecture,pleasegoonlineanddothepracticequestionsand
cases(throughthecasebookorthroughtheVirtualPatient)associatedwiththechaptersread.Thiscombinationofreading,listeningtolecture,andquestionsandcasesprovides
UICDepartmentofSurgery 35
fourmethodsofreinforcementofthematerial.Ifyouadheretothisschedule,allfourmethodsoflearningwillbecompletedbytheendofthe7thweek.
4) The8thweekshouldbecomprisedofreviewbookofquestionsandcasereviewtoassessknowledge,identifyinggapstoaddressagainwithcaseandquestionreviewexplanations.
5) Wewantyoutobethebestinthecountry.Beingsotakestimeandeffort.Everyone
acceptedtomedicalschoolsaroundthecountryisassmart.Howyousetyourselvesapartfromtherestofthestudentsinthecountryishowhardyouworkandhowdisciplinedyoucanbeinadheringtoyourstudyschedule.Wehopethatyourisetothechallenge!Goodluckandpleaseemailorcallwithquestionsorconcerns.
Appendix7HIPPACOMPLIANCE
MedicalstudentsareexpectedtoreviewONLYtheelectronicrecordsofthepatientsontheirassignedserviceduringthespecificdatesoftheirclinicalrotationscheduleaspartoftheireducationallearningexperienceandclinicalexposure.Thiswouldincludereviewingrecordsofthehospitalizedpatientsduringthespecifiedtimeoftherotationaswellasthoseofoutpatientsthatareseenintheclinicduringthattime.MedicalstudentsareexpectedtofamiliarizethemselveswithALLthepatientsthatareontheservice.Studentsareprovidedloginandpasswordsbythemedicalcentertoaccessthepatients’electronicrecordswhileontheserviceforanyspecifiedrotation.Studentsarealsoregularlyaskedtoreviewthoseelectronicrecordsadaybeforeinpreparationfortheclinicdayandalsotogobackandreviewtheirrecordsaftertheclinicdayisoveraftertheattending’sclinicconsultnoteisdictatedandenteredsothattheycanlearnwhatconstitutesadequatedocumentation.StudentsaresometimesaskedtowritesomepartoftheHistoryandPhysicalNotethatpertainstosystemreviewasaclinicaltrainingexerciseiftheysawthepatientwiththefacultymember.
StudentsrotatingontheserviceareexpectedtoabidebyHIPPArulesandmustnotdiscloseorpassanyinformationaboutaspecificcasetoanypersonwhoisnotinvolvedinthecareofthesaidpatient.Theymaynotdiscusspatientdatainpublicareassuchaselevators,cafeteria,orotherplaceswherelaypeoplecouldoverhearthesediscussions.StudentsMAYNOTaccessaspecificrecordaftertheyfinishtheirclinicalsurgicalrotation,unlesstheybecomeinvolvedagaininthecareofthepatientonanotherservice.IFTHESTUDENTACCESSESANYPATIENTRECORDSWHICHARENOTASSOCIATEDWITHTHESTUDENT’SASSIGNEDCLINICALSERVICEDURINGTHEASSIGNEDROTATIONORATATIMEOTHERTHANTHESAIDROTATION,THESTUDENTWILLFACEDISCIPLINARYMEASURESANDPOSSIBLEDISMISSALFROMMEDICALSCHOOL.