SURU-4008 - A/I in Plastic Surgery

SURU-4008 - A/I in Plastic Surgery

Elective Title: A/I in Plastic Surgery
Course Number: SURU-4008
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 4
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Surgery Clerkship.
Responsible Faculty Director: Dr. Abigail Forbes Periods Offered: 1-13 including holiday period 8 
Coordinator: Amy White Other Faculty: Ludwik Branski, MD Eric Cole, MD; Linda Phillips, MD; Daniel Donato, MD; Petros Konofaos, MD; Ramon Zapata-Sirvent, MD; Baojing Qin, MD
Location to Report on First Day:
Course Coordinator, Amy White, 6.132 McCullough

Goals
To familiarize the student with basic patient care activities in a broad plastic surgery service. To enhance skills in diagnosis and treatment options for patients with a range of plastic and reconstructive issues including: breast, hand, maxillofacial, soft tissue tumor, aesthetics, microsurgery, burn and chronic wound reconstruction. Understand more of the physiology of these conditions.

Objectives
To learn technical skills including: evaluation and work-up of skin lesions and wounds, appropriate debridement, excisions and a proper layered laceration closure to optimize healing. To improve skills in the history and physical examinations of chronically wounded patients as well evaluate patients for massive weight loss surgery. Evaluate multiple types of acute hand and facial injuries and learn how to triage them appropriately. To acquire knowledge of what can be accomplished with reconstructive surgery and when a patient is an appropriate candidate for Plastic Surgery reconstruction. Demonstrate proficiency in suturing as well as improved efficiency in the OR and rounds.

Description of course activities
Within limits set by law and hospital rules, student will function with the same responsibilities and duties as an intern or first year house officer. Students will be involved in daily work-up and evaluation of patients both in the hospital and in the outpatient clinics. Approximately 40 patients will be seen per week in these settings. They will be given an opportunity to participate in information gathering on in-patients rounds, writing notes and evaluating patients with residents in the clinic. They will also participate in surgical procedures which will include observation, intra-operative case discussion and hands-on operative activities depending on the student level and case complexity, as described in the above objectives. Students will have same hours and call responsibilities as an intern and will be in attendance on Mondays/Wednesdays for education conference as well as our monthly Journal clubs. The student will present an assigned article at the Journal club.

Student will rotate between CLC, LCC, or UTMB campuses. The OR or clinic assignment will depend on the weekly rotation that they are assigned to.


Students will be required to participate on inpatient rounds in AM and PM at each site (League city and Galveston) with their respective resident team for that week. They will help with daily dressing changes on inpatients during these rounds and writing daily notes. They will perform bedside evaluations and report back to resident team if RN has any concern about a patient on the floor.

They will be able to see their own patients in clinic and write clinic notes when appropriate (pending diagnosis complexity) in each of the outpatient clinics (hand, craniofacial, recon, breast). They will also be given the opportunity to place orders for the patients that they see. Pending the complexity, they may be able to present directly to attending or they will present to a resident first. They will also provide patient counseling independently.


They will attend TDC clinic each Friday where they will evaluate their own patients, present to attendings and write notes as well as perform in clinic procedures. These TDC Procedures can include, but not limited to: lasers, wound debridements, suture removal, skin lesion or soft tissue mass excision and closure, steroid injections, maxillomandibular wire fixation removal etc. They will learn how to properly draw up and inject local anesthesia for these bedside procedures as well.

Each day, they will be assigned to either a clinic or OR depending what it’s going on that day and which location they are assigned to. They will be aware of what they are assigned to ahead of time so they can do the proper preparation for clinic patients or case. In the OR, they will scrub, help assist with surgery and suture when appropriate. They will learn how to safely be efficient in the OR and are expected to do the same tasks as interns for patient prep and at end of case.
They will round on the patients they operate on daily.

They will spend one weekend of the rotation on “home” call (Friday-Saturday-Sunday) . They will come in to see ED consults and perform bedside ED procedures with a lower level resident supervision (pgy1-3). They will scrub in the OR if any consult requires operative intervention over the weekend. They are expected to round with residents on Saturday and Sunday in Galveston. They may pick 2-3 patients to present on these rounds.
They will assist the intern in gathering supplies for bedside dressing changes/procedures during pre rounds and participate in the bedside procedures.

Students will also present a “Planning and Outcomes” presentation one Monday during the divisional education conference during their rotation. This will include a PowerPoint presentation of a patient they have seen in clinic or on call. The presentation will include patient history, photos, diagnosis, treatment and background of the chosen treatment. This will be reviewed with a resident or faculty before presenting. They will be given faculty and resident feedback for their presentation.




Type of students who would benefit from the course
Those planning on going into a surgical specialty, Family Medicine, Emergency Medicine or Dermatology will particularly benefit from the technical and didactic information. All students could benefit from the basic anatomy, evaluation and physiology of these challenging issues.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday OR vs clinic OR vs clinic
Tuesday OR vs clinic OR vs clinic
Wednesday OR vs clinic OR vs clinic
Thursday OR vs clinic Journal Club Conference
Friday TDCJ Clinic OR vs clinic
Saturday
Sunday

 Average number of patients seen per week: 40
 Call Schedule: Will take one weekend of call (Friday 5pm-Monday 7am, home call) while on 4 week rotation Will intermittently assist intern with 7am-5pm consults Monday-Friday if educational and if they are at the same campus as consult

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Data-Collection/Analysis
Other


Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Daily by both faculty and residents in both operative and clinic settings
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Both to faculty and residents on in-patients, clinic patients, read and present journal articles
  B. Frequency / Duration of Presentation(s)?
    Daily patient presentations, bi-weekly journal conference topics
  C. Format - What guidelines are set for the student's presentation?
    Patient evaluation followed by presentation orally in rounds or clinic, H&P or SOAP format
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    Weekly clinical H&Ps on at least 3 patients, weekly progress notes on at least 5 patients they have seen from rounding or consults
  B. Format - What guidelines are set for the student's written work?
    Same as used by physicians. H&P that includes history of presenting illness, past medical history, medications, past surgical history, family history, social history, assessment, and plan. Progress notes in SOAP format. We will share our Plastic Surgery note templates with students and review how to go through it.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    The student will participate in morning rounds, take an active roll in the operating room, evaluate and assist in the treatment of clinic patients, participate in division conferences and journal clubs.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Carried out by the residents and the staff on a week-to-week basis.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    Student will be encouraged to seek out oral feedback after OR, clinic or rounds from Faculty and Residents. Student can meet halfway and at end of their rotation with Student Director to review feedback.
 
B.
Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    Advanced assessment and planning of patient
Layered suturing
Debridement and wound care dressings
Bedside in patient procedures
Efficiency in patient rounding and OR
 
C.
How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    Advanced operative and clinical skills set. Proper evaluation, management and triage of acute hand/facial injuries
 
D.
What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    The AI will be expected to know the clinical status of all patients on the service, including the plan discussed at rounds, follow-up on results from tests, interpretation of results of diagnostic studies, and to communicate results to the team in an appropriate time frame. The student will be expected to recognize when to escalate care or when information needs to be urgently communicated to the resident or faculty. Student will be given opportunity to perform suturing.
Student may get to use Bovie or Scalpel in the OR pending case complexity level and student initiative/preparedness.
 
E.
An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    The student will have an opportunity to function as an intern, to experience a more rigorous set of clinical demands, and be supported as he/she develops the knowledge, behaviors and attitudes to successfully care for surgical patients as part of a resident team. They will be able to write patient notes under supervision of a resident or faculty.
 
F.
How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    The student will present on rounds daily with residents and faculty. These presentations will include a synthesized assessment and plan. Student will receive immediate feedback from residents and faculty. The course director will meet with the student once at midpoint to also provide formal feedback.
 
G.
How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Midpoint feedback provided via phone call or Teams meeting from Student Director. We will optimize students weekly schedule assignments in order for them to remediate any identified deficiencies
 
H.
Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    3-4 faculty are encountered during the rotation for 3 to 5 days per week, however this can easily be tailored to students’ specific interest.
Student will receive significant interaction with both faculty and residents.
The residents working with the student will be those on service ranging from intern to chief. Students can obtain letters of recommendation from any of the faculty that they have spent significant time with. Feedback will be solicited from faculty and residents at mid-point and then again at the end of the course. It will be communicated to the student by the course director.