Welcome to your Surgery Clerkship!

Dr. Tatum photo Link to Dr. Roger Tatum's Biography on UW Medicine website This is no doubt a six-week experience that is eagerly anticipated by some, and dreaded by others. It is our sincere hope, however, that both during and after your time with us, regardless of your ultimate career path, you will have not only gained new and useful knowledge, but actually enjoyed yourself. During the clerkship, you will have opportunities to see things you will not see elsewhere, and participate in patient care in a very in-depth and all-around manner. You will develop new skills and be able to apply them, both now and down the road. In short, though there is much work to be done, and much to learn, the experience is guaranteed to be EXCITING.

Now, with that point across, it is important to emphasize the one overriding goal of this clerkship: your learning. Nothing else takes precedence. Though there are many tasks you will perform and many responsibilities that you will be given, please do not lose sight of this very worthwhile goal. Thus, if you must leave rounds to attend a lecture, or would like to see another case in the OR instead of hanging around the ward, you are obligated to do whatever will maximize your benefit from this clerkship. That having been said, here is a brief summary of the general objectives of the clerkship (these appear in more detail elsewhere on the website):

  • In patients with surgical problems, demonstrate a method of focused evaluation, including the approach to workup and preparation of patients for anesthesia and surgical intervention
  • Identify what constitutes appropriate surgical referral by recognition of which problems are clearly surgical, potentially surgical, and those which do not require surgical intervention
  • Perform a thorough abdominal exam in the presence of a faculty preceptor, evaluating for pain and tenderness, abdominal distension, abdominal masses, hernias, and bruits
  • Identify the important factors in the diagnosis, workup, and management of specific surgical problems in the following categories:
    • Acute abdomen
    • Bowel obstruction
    • GI hemorrhage
    • Hepatobiliary and pancreatic disease
    • Endocrine disease (thyroid, parathyroid, and adrenal)
    • Breast disease
    • Vascular disease (carotid, aortic, and peripheral vascular)
    • Cardiac and thoracic disease
    • Trauma, burns, and surgical critical care
    • Pediatric surgery
    • Plastic surgery
  • Perform some basic surgical techniques, particularly basic suturing skills and general wound management
  • Evaluate and critique an article from the surgical literature

With so many things to accomplish, this will be one of the more time-consuming clerkships of your medical school career. In addition to a large amount of reading, you will also be faced with a large number of very sick patients. Such patients require daily physical examination, dressing changes, blood drawing, I.V.'s, and comforting. It is a secondary goal of your clerkship to deal with the routine matters of patient care in an efficient and organized manner. This is the foundation for the rest of your medical career, and the more efficiently you learn routine ward care now, the more time you will have for other activities in the future.

A Word About Reading

Because students may choose from a list of recommended texts and because the topics are organized according to patient problems rather than system diseases, there are no specific reading assignments. Reading about a specific topic will require you to read and glean information from several chapters within a text. The lectures and seminars are designed to consolidate this information into concepts applicable to patient care. Your clinical ward evaluations as well as the written examination will measure the extent to which you have succeeded.

The two textbooks students find most useful are:

  1. Greenfield J, et al. Essentials of Surgery: Scientific Principles and Practice. Philadelphia: Lippincott, Williams, & Wilkins, 1997. 835pp.
    • Well-organized and thorough, somewhat more in-depth text
  2. Lawrence PF. Essentials of General Surgery, 4th ed. Philadelphia: Lippincott, Williams, & Wilkins, 2006. 613pp.
    • Topics somewhat more broad, but very digestible, somewhat easier to get through

Selection of either text is truly a matter of personal preference; be sure to look at booth before buying one or the other.

Mechanics of the Clerkship

At the completion of the orientation session, you will go to your assigned hospital where you will be instructed in sterile technique, the mechanics of preparing to operate, and in some cases, to nursing units for orientation. A wound closure laboratory at University Medical Center is generally scheduled during the first week of the rotation to teach you basic suturing skills and familiarize you with the mechanics of wound healing.

The following points are pertinent:

Schedules

You will be on call every fourth night on average. You may swap nights with each other as necessary, provided your residents and the paging operator know about the change. At some sites, when you are "on call" you are expected to be available in the hospital; and the residents, ward nurses, and the paging operator should know where you are at all times. You must never be out of reach of a telephone with the number known by all appropriate personnel. At the WWAMI sites and Swedish, call will typically be taken from home, and you will be called with any ER or hospital consult, or case requiring operative intervention. The call schedule obviously includes weekends when you are on call. You will be excused from duty on recognized University holidays.

Rounds

You should be following two to three patients throughout their hospital course at all times. Regardless of the structure of your individual clerkship site, you can get the maximum benefit from making rounds in the morning, see your patients before rounds and contribute to the team by reporting any findings or important lab or test results to the group. Except for the nights when you are on call, you will be expected to leave after late afternoon or early evening rounds. You may be expected to make rounds on Saturday morning but need not remain for the rest of Saturday or Sunday unless on call. You will be off on official University holidays.

Housestaff

At UWMC, HMC, VAMC, VMMC, and the Boise VAMC, you will be part of a surgical team and much of your day-to-day learning will come from residents. The residents are aware of this, and each resident has been carefully chosen, not only for his/her excellent record and potential for being an excellent surgeon, but also for his/her willingness to impart knowledge to others. However, residents, as you will soon realize, are very busy; they sometimes feel they are "in over their heads" themselves, and will sometimes forget your presence and be sure you are included in their activities. Please inform the Hospital Clerkship Coordinator or me of any ongoing interpersonal problems so they can be rapidly and fairly addressed.

Conferences

You should attend all regular department and hospital conferences. Check with your resident for the topics covered each week.

Hospital/Operative Log

You will be asked to complete an on-line case/patient exposure log, consisting of at least one diagnosis in each of several categories. Please record the diagnosis (please do not record patient names), and check the boxes to indicate whether you evaluated the patient in clinic, followed them in the hospital, and/or scrubbed into their case in the OR (check all that apply). Toward the end of the clerkship, if you have not had an experience in a particular category or categories, you will be asked to complete one or more web-based case scenarios (starting January 2007). Then, check the box in the "case scenario" column. Your completion of this checklist is required and will be monitored, but your actual performance of the tasks is your own responsibility; as with other aspects of your medical education, the "honor system" is in effect.

Grading

The Dean's office receives your final grade as "Honors", "High Pass", "Pass", or "Fail". Both Summative Comments (a description of your performance) and Formative Comments (prescriptive comments that can identify specific problems) are made on the grading form. They represent the consensus of your entire clerkship performance.

Your grade is made up of two parts:

  1. Ward Work: This is obviously the most important single component of your final grade, as you need Honors in your ward work plus Honors in the written exam to receive Honors for the clerkship. The process by which we determine your clinical grade is as follows:
    • The residents and faculty who work with you develop a consensus evaluation of your clinical performance. Components of this evaluation include your data base, cognitive and verbal skills, educational attitude, various technical skills, knowledge of your patients, initiative and interest, dependability, and interpersonal skills, including relationships with fellow workers and patients. The hospital clerkship coordinator summarizes the comments from faculty and resident staff as formative and general evaluation statements. These are the basis of your clinical grade and are transmitted to the Dean's office for inclusion in your SOM file.
  2. Written Exam: This exam is given on the last day of the clerkship (8:30 to 11:00 am). It tests for cognitive information and consists of 100 multiple choice questions focusing on general aspects of surgery which you were exposed to on the wards, in the Reading Seminars, and through your reading.

Course Evaluation

Before the written exam on the last day of the clerkship you will be required to fill out a course evaluation form. This is your way of grading us, and our way of evaluating the strong and weak points of the clerkship. Please be specific, honest, and constructive- -mention people by name who have or have not been helpful. You may remain anonymous, but please indicate which hospital you were assigned to. Copies of the course evaluations are forwarded to the Hospital Clerkship Coordinators, the Department Chairman, and the Directors of the Residency and Faculty Advancement Programs for their review and action. We are constantly changing and trying to improve the clerkship. Your response on the feedback sheet gives us the best opportunity to do so.

Summary

This clerkship is like any other human endeavor: what you get out of it depends on what you put into it. While it will be time consuming and demanding, we do not intend to make you trained surgeons in six weeks. We do, however, hope to give you an appreciation of surgical disease, some insight into what surgeons do, and an understanding of "when to call the surgeon" (and also what to do before he/she gets there)!

We want you to learn, grow, and enjoy this experience with general surgery, one of the essential primary care disciplines. Should any problems arise during your surgery clerkship, please speak with the Clerkship Coordinator at your assigned hospital. Problems that cannot be resolved by the hospital Clerkship Coordinators will be referred to me. In addition, you may always call the Student Education office at 685-0975 should you have any logistical questions or dilemmas.

Roger P. Tatum, MD
rtatum@uw.edu
Assistant Professor
Director of Medical Student Surgical Education
University of Washington Department of Surgery

updated 7/07

Work Hours Policy
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The goals of the medical students and the faculty of the School of Medicine are one and the same: to get the best medical education possible while not ignoring overall health and happiness. Attention needs to be paid to both duty/work hours and personal time.

Work hours rules have been developed for residents, but similar rules have not been developed for medical students. There are obvious differences in terms of goals, reimbursement, and responsibilities between residents and students. Nonetheless, some guidelines for students apply.