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Department of Surgery
MSC 10 5610
1 University of New Mexico
Albuquerque, NM 87131-0001
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The Department of Surgery
Phase II Surgery Clerkship
Clerkship Objectives
It is anticipated that the student will master portions of the overall school objectives during the Surgery rotation. These include but are not limited to the following objectives.
Altruism | Knowledge | Skillfulness | Dutiful
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Altruism
- Knowledge regarding ethical decision making: Students may have the opportunity to witness and participate in end of life discussions with patients and their families. Additionally, there should be ample opportunity for the student to observe and participate in the informed consent process.
- Compassionate patient care and respect for the privacy and dignity of their patients: Patients who are undergoing surgery face unique psychological and social stresses. It is imperative that the students exercise compassionate care and respect for patient privacy throughout the peri-operative period. It is important not to discuss operative findings in areas of the hospital where the discussion might be overheard by friends or families of the patient.
- Honesty and integrity in all interactions with patients' families, colleagues, and others with whom physicians must interact professionally: The student is expected to wear a clean white coat with name tag at all times except in the operative suite. All patients are to be addressed as Mr., Mrs., etc. Any discussion of diagnosis, management, or prognosis with the patient or family should be first cleared with the housestaff or attending physician.
- An understanding of, and respect for, the roles of other health care professionals, and of the need to collaborate with other in providing care for individuals and populations: Surgeons typically pride themselves on their ability to manage patients throughout all of the phases of their illness. However, medicine has a very sophisticated science, and collaboration with other health care professionals can be expected. Most medical students will not choose a surgical career, but students should consider that they will likely consult with and be consulted by surgeons throughout their professional careers.
- The capacity to recognize and accept limitations in one's knowledge and clinical skills: Surgical therapy typically produces extreme results. Positive outcomes are extremely rewarding but negative outcomes are immediate and devastating to the patient and humbling to the surgeon. The best application of the most current surgical therapy does not guarantee positive outcomes. This situation should result in reflection on the part of all members of the team. Sometimes, ideas arise after failure that results in progress in knowledge.
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Knowledge
- Knowledge of molecular, biochemical, and cellular mechanisms underlying the pathology of disease: The surgeon must have a comprehensive knowledge of basic science disciplines. The student will have the opportunity to correlate his or her preclinical basic science knowledge with the care of the surgical patient.
- Knowledge of pathologic changes in the structure and function of organ systems as a result of disease: Surgery is unique in the degree of clinical correlation that can be accomplished. The student can detect findings on a preoperative physical exam, view radiographs and then be able to see and directly palpate the patient's pathology. Responsibility for making this possible is shared among the students, residents, and surgical faculty.
- Knowledge of mechanisms of drug-action, pharmokinetic parameters, pharmacodynamics and pharmacotherapeutics: Students will have an opportunity to see a number of medications used in the perioperative period. This should be an excellent opportunity to review the pharmacology of many antibiotics, analgesics, anesthetics, etc.
- System Based Practice: Through direct patient care in the impatient and outpatient settings, students are expected to understand the various roles of health care professionals, health care systems, and society. Attending input during tutorials, patient presentation, and rounds will show how each affects the other. Students will be exposed to both the private and university care settings. Students will be expected to understand the aspects of practicing with cost effectiveness in mind, and not by a shotgun approach. Utilizing the means available to assure good patient care (social services, patient advocates, third party paying systems).
- Practice Based Learning and Improvement: Students are encouraged to utilize external resources to understand why we do what we do. Students are expected to make use of information technology to find patient information (Powerchart/Brahms/VA computer systems). Access of online clinical studies are to be found to support patient care, and presented during attending rounds.
- Skills for life-long learning: The hours are long for most surgeons. he call schedule has been modified in an attempt to provide students with adequate time for rest and study. Despite these modifications, it is expected that Surgery will be one of the most rigorous and demanding experiences of the student's medical school educational experience. One misconception that leads to problems is the some students believe that they should only study when away from the hospital. Instead, the student must develop a strategy that allows them to read and study during any free opportunity during the working hours. Developing this skill will also be useful to the student during residency training, and in future post-training practice.
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Skillfulness
- The ability to perform both a comprehensive and organ system specific examination: The surgeon must assess the patient's entire state of health prior to performing an operative procedure. Therefore, the student will gain experience with a comprehensive physical examination during the rotation. Additionally, the student may have an opportunity to learn a very detailed examination of specific organ systems. This will vary according to the specific nature of the student's rotations.
- The ability to perform routine technical procedures (E.G., nasogastric tube insertion, venipuncture, intravenous catheterization, arterial puncture, urinary catherization, suturing, skin stapling): Students frequently fail to recognize the opportunity to perform procedures on patients in the Operating Room. Doing procedures in this environment minimizes patient discomfort and allows the student to learn to do a procedure under supervision.
- The ability to interpret the results of commonly used diagnostic tests with recognition of their limitations: Frequently, a surgeon will be required to make decisions based on inconclusive tests. The student should inquire frequently as to why specific tests have been ordered.
- Knowledge of the most frequent clinical laboratory, radiologic, and pathologic manifestations of common maladies: The surgical pathologists are frequently willing to review the pathologic evaluation of tissue that has been removed at surgery. The radiology faculty and housestaff are consistently available to review perioperative imaging studies.
- The ability to reason deductively in solving clinical problems: The residents and faculty will be able to explain to the student how they have arrived at diagnoses and developed plans.
- The ability to construct appropriate diagnostic and management strategies for patients with common surgical conditions: This applies to both the conditions that the student actually encounters in patient and those only read about in textbooks.
- Knowledge about relieving pain and ameliorating suffering: This will be particularly true in the post-operative period. There are a variety of ways to relieve post-operative pain, and the student should be familiar with these options.
- The ability to communicate effectively with patients, their families, and members of the healthcare team: The unique aspect of surgical care is that often the surgeon must establish a relationship quickly in a stressful situation. Effective communication is important in guiding a patient, and his or her family, through these situations. The students will witness and participate in this process.
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Dutiful
The ability to retrieve, manage and utilize biomedical information for solving problems and making decisions relevant to the care of individuals: The surgeon must synthesize clinical, laboratory, and radiologic information to solve problems with or without surgical intervention. The student will be an active participant on the surgical team.
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