Student Manual June 2017 with new passing rate · TABLE 6 THIRD YEAR CORE CLERKSHIP GRADE SCALE 16...

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


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


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;


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.


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


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.


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


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)


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/


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


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.


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.


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


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


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.


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


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


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


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


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.


Appendix1ClinicalSitesandContactInformationHospital Address SiteDirector SiteCoordinatorAdvocateChristMedicalCenter

4440W.95thStOakLawn,IL60453708.684.8000

BryceBardezbanian,[email protected]

ColletteKotarski708.684.5684colletta.plonis-kotarski@Advocatehealth.comCherieOvercastGMEcoordinator708.684.5450Cherri.overcast@advocatehealth.com

AdvocateIllinoisMasonicMedCenter

3000N.Halsted,Suite711Chicago,IL60657Office:773.296.3390

NikolaosDallas,[email protected]

[email protected]

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,[email protected]

[email protected]

MercyHospitalandMedicalCenter

2525SouthMichiganAvenueChicago,IL60616312.567.2211

AndyPerrott,[email protected]

[email protected]

St.FrancisHospitalofEvanston

355RidgeAvenue

Evanston,IL60202847.316.4000

MichaelPrendergast,MD

[email protected]

CatherineClark,[email protected]

St. 2900NorthLake MarkConnolly,MD KathyMcGaghie


JosephHospital

ShoreDriveChicago,IL60657773.665.3000

[email protected]

[email protected]

StrogerHospitalofCookCounty

1901W.Harrison,Chicago,IL60612312.864.6000

ThomasKomar,MDPgr:[email protected]

[email protected]

UniversityofIllinoisatChicago

840S.WoodSt.,518-EChicago,IL60612312.996.7000

SiteDirectorScottZiporin,MD,FACSCell314.369.1380ziporins@uic.eduCo-SiteDirectorFrancescoBianco,MDCell312.636.3591

[email protected]

[email protected]

Mt.SinaiHospital

1500SouthCaliforniaAve.RoomOS351–MainHospitalChicago,IL60608773.542.2000

[email protected]

SusieAvila773.257.6777avis@sinai.orgResidencyCoordinatorVanessaSalazar773-257-6464Vanessa.salazar@sinai.org

WeissMemorialHospital

4646N.MarineDrive60640CElevator,7thFloorChicago,IL773.564.5187

BernardoDuarte,[email protected]: 630. 247.1160

EricaDelgadoOffice (Weiss): [email protected]

ClerkshipDirectorAmeliaBartholomew,MD,MPH,FACS909SouthWolcott,Suite5060(lab),Room5113(office)[email protected]@mac.com

AssistantDirectorRobertArensman,MDCelltelephone773.919.6064Pager773.514.3839

[email protected]


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.


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/


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.


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.


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


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


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


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


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


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


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


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.

Student Manual June 2017 with new passing rate · TABLE 6 THIRD YEAR CORE CLERKSHIP GRADE SCALE 16...

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