Surgery Obj

8/10/2019 Surgery Obj

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COURSE OBJECTIVES

SPECIFIC SURGERY PRACTICUM OBJECTIVES/STUDY TOPICS

1. Perform and document an admission history and physical examination, with identification and discussion of normal and

abnormal findings.

2. Describe indication and techniques used in providing universal precautions and infection control procedures or patients and

health care workers including sterile surgical technique.

3.

Develop and document assessment and plan in the inpatient &/or outpatient record.

4. State the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications

commonly used in surgical practice.

5. For patients presenting with the conditions listed below (Common Surgical Entities):

A. Perform a problem-oriented history and physical examination,

B. List related differential diagnosis.

C. Determine a tentative diagnosis.

D. Direct a primary care diagnostic evaluation and

E. Order, a primary care-level clinical treatment plan, which includes:

Pharmacologic and non-pharmacologic interventions

Patient education Further diagnostic studies

Appropriate referrals or consultation; and follow-up

F. Common Surgical Entity Topics

Acute surgical abdomen

Intracranial tumor/aneurysm/AVM

Goiter/neck mass

Carotid ASHD

Lung tumor

Pulmonary embolism

Pneumothorax/hemothorax

Breast mass/cancer

Mallory- Weiss syndrome

Esophageal varices

Peptic ulcer disease

Gastritis

Gastric carcinoma

Cholecystitis/lithiasis/cholangitis

Pancreatitis

Bowel obstruction (small and large)

Meckels diverticulum

Diverticulitis

Appendicitis

Mesenteric adenitis

Crohns disease

Thrombophlebitis Volvulus

Intussusception

Colon cancer

Hemorrhoids

Anal fissure

Perirectal abscess

Portal hypertension

Hernia (hiatal/abdominal/inguinal)

Arteriosclerotic occlusive disease

Renal calculi

Prostatic hypertrophy


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Hypovolemic shock

Septic shock

Aortic aneurysm

Injured/burned patient

General Surgery (4 weeks)

By the end of the general surgery practicum, the student should possess a thorough understanding of the following concepts as they

relate to the care of the surgical patient:

1. Pre, peri and post operative evaluations and care

2.

Fluids and electrolytes3.

Nutrition

4. Surgical bleeding and blood replacement

5. Shock

6. Wounds and wound healing

7.

Surgical infections

8. Trauma

9. Burns

Additionally, the student shall be expected to achieve a fundamental understanding and knowledge of the diagnosis and

management of surgical disease states involving the following anatomic regions, systems or conditions:

1. Abdominal wall including hernia

2.

Esophagus

3.

Stomach and duodenum

4. Small intestine and appendix

5. Colon, rectum and anus

6. Biliary tract

7.

Pancreas

8. Liver

9. Breast

10. Surgical endocrinology

11.

Spleen

12. Surgical oncology

The student should be able to recognize (through appropriate use of historical and physical examination skills), and know the

differential diagnosis and management of the following post-operative complications:1. Fever

2. Wound infection

3. Pulmonary embolism

4. Pneumonia

5. Urinary retention

6. Ileus

7. Constipation

8. Renal failure

9. Wound dehiscence/evisceration

10. Adhesions 5

11. Atelectasis

12. Arrhythmias

13. Deep venous thrombosis

14. Hematoma

15. Urinary infection

While the general surgery rotation shall have as its focus surgery as a discipline, the student is expected to acquire an appreciation

for surgery as a craft. Patient care opportunities in the ambulatory clinic, hospital wards and operating room should be used by the

student to develop the following skills:

1. Sterile technique to include scrubbing, gowning, gloving and care of the operative field.

2.

Use of surgical instruments.

3. Wound care including simple suture techniques, debridement and dressings.

4. Application and care of surgical drains and tubes.


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At the completion of the rotation in general surgery, the student should be able to apply his/her knowledge of the foregoing

concepts to the management of patients with medical problems frequently encountered by the general surgeon. Such clinical

presentations may include those discussed during the course of the rotation or any of the following:

1. Breast complaints

2.

Abdominal pain or mass

3. Jaundice

4. Intestinal obstruction

5. Upper or lower gastrointestinal bleeding

6.

Soft tissue infection

Formulate clinical conclusions regarding the interpretation of the following tests or procedures and discuss advantages and

disadvantages of these tests or procedures as well as the use of each.

Abdominal plain film

Abdominal Ultrasound

Barium enema, with & without air contrast

Chest X-ray

CT scans

Electrocardiogram

Intravenous Pyelography

MammogramMRI

Oral cholecystogram

Plain-film radiographs(spine, extremities,

chest, abdomen)

Nuclear scans


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SPECIFIC SPECIALTY SURGICAL PRACTICUM OBJECTIVES/STUDY TOPICS

Orthopedics (4 weeks)

At the end of the orthopedic section of the clerkship, the student should:

1. Demonstrate the ability to perform and discuss the orthopedic history and physical examination.

2.

Be able to interpret x-rays of the musculoskeletal systems.

3. Outline the treatment rationale of the more frequently encountered orthopedic problems.

4. Demonstrate knowledge and understanding of conditions presenting to the orthopedist, prioritize patient care,

develop a differential diagnosis, and recommend appropriate therapeutic interventions.

5.

Accurately identify all true orthopedic emergencies that could result in the loss of life, limb, and/or cause permanent

disability.

6. Be able to recognize the patient presenting with a fracture and/or dislocation, prioritize the care for this patient,

develop a differential diagnosis, and initiate appropriate and immediate therapeutic interventions.

7.

Be able to recognize the patient presenting with cervical spine trauma, prioritize the care for this patient, perform a

differential diagnosis, and initiate appropriate and immediate therapeutic interventions.

8. Function as assistant in orthopedic surgery commensurate with ones level of education.

Cardio-Thoracic and Vascular Surgery (4 weeks)

At the end of the cardio-thoracic/vascular section of the practicum, the student should:

1. Demonstrate familiarity with the various diagnostic and physiologic tests used for evaluating patients with vascular

diseases.

2.

Demonstrate knowledge and understanding of conditions presenting to the cardio-thoracic/vascular surgeon, prioritizepatient care, perform a differential diagnosis, and recommend appropriate therapeutic interventions.

3. Participate in the management of a variety of patients with arterial and venous diseases. Be able to recognize the

patient presenting with an ischemic extremity, prioritize the care for this patient, perform a differential diagnosis, and

initiate appropriate therapeutic interventions. Be able to recognize the patient presenting with pneumothorax,

prioritize the care for this patient, develop a differential diagnosis, and initiate appropriate and immediate therapeutic

interventions.

4. Demonstrate a working knowledge of cardiac and thoracic disease processes and their management. Be able to

recognize the patient presenting with severe cardiac disease, prioritize the care for this patient, develop a differential

diagnosis, and be able to initiate appropriate and immediate therapeutic interventions.

5. Demonstrate knowledge and understanding of conditions requiring cardiac transplantation, including ability to

prioritize transplant candidates.

6.

Participate in the management of a variety of patients with diseases of the cardio-vascular and thoracic systems.

7.

Demonstrate understanding of the pre and post-operative care requirements for patients undergoing general cardio-

thoracic surgery as well as the special requirements for patients undergoing transplantation.

Otorhinolaryngology (ENT) (4 weeks)

Emphasis during the ENT section of the practicum will be on outpatient care. At the end of this section, the student should:

1. Demonstrate skills in history taking and interviewing by working up patients with problems related to the head and

neck.

2.

Demonstrate knowledge and understanding of conditions presenting to the otorhinolaryngologist, prioritize patient

care, develop a differential diagnosis, and recommend appropriate therapeutic interventions.

3. Discuss fundamentals of otoscopy, rhinoscopy, indirect laryngoscopy, and head and neck examination.

4. Demonstrate increased clinical judgement in evaluating surgical problems.

5.

Discuss the problems of communicative disorders and hearing loss.

6.

Observe and assist in surgical procedures related to facial plastic surgery and otorhinolaryngology.7. Develop expertise in suturing and management of wounds.

8. Be able to recognize the need for identification of anatomic location of bleeding site in epistaxis, plan appropriate

immediate care, and make recommendations for long-term care.

9.

Be able to recognize the patient presenting with airway obstruction, prioritize the care for this patient, and initiate

appropriate and immediate therapeutic interventions.

Urology (4 weeks)

At the end of the urology section of the practicum, the student should:

1. Observe and participate in the preoperative evaluation, surgical management, and postoperative care of urologic

patients.


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2. Demonstrate knowledge and understanding of conditions presenting to the urologist, prioritize patient care, develop a

differential diagnosis, and recommend appropriate therapeutic interventions.

3.

Demonstrate skill in interviewing and examining patients with urologic disorders.

4. Demonstrate improved acuity of clinical judgement and the ability to select diagnostic tests and common ward

procedures as they pertain to urologic patients.

5.

Be able to recognize the patient presenting with hematuria, prioritize the care for this patient, perform a differential

diagnosis, and initiate appropriate therapeutic interventions.

6. Be able to recognize the patient presenting with a urinary obstruction, prioritize the care for this patient, develop a

differential diagnosis, and initiate appropriate therapeutic interventions.

Plastics (4 weeks)

At the end of the plastic surgery section of the practicum, the student should:

1. Compare and contrast different types of grafts (auto, allo, split and partial thickness, etc.)

2. Review special needs of burn patients requiring extensive reconstruction.

3.

Discuss cosmetic vs reconstructive plastic surgery.

4. Review indications and contraindications to grafts and flaps.

5. Recognize conditions covered by insurance referred to plastic surgeons.

6.

Demonstrate appropriate suture techniques for cosmetic closures.

7. Identify the patient that requires a referral to a plastic surgeon.

Neurosurgery (4 weeks)

At the end of the neurosurgery section of the practicum, the student should:

1.

Demonstrate the ability to perform and discuss the complete neurological history and physical examination.

2. Be able to interpret radiographic studies (plain films, CT scans, MRI scans, angiograms, myelograms) of the brain,

cervical, thoracic and lumbar spine systems.

3. Outline the treatment rationale of the more frequently encountered neurosurgical problems.

4.

Demonstrate knowledge and understanding of conditions presenting to the neurosurgeon, prioritize patient care,

develop a differential diagnosis, and recommend appropriate therapeutic interventions.

5. Observe and participate in the preoperative evaluation, surgical management, and postoperative care of neurosurgical

patients.

6.

Demonstrate improved acuity of clinical judgement and the ability to select diagnostic tests and common ward

procedures as they pertain to neurologic patients.

7. Accurately identify all true neurological emergencies that could result in the loss of life, limb, and/or cause permanent

disability.

8.

Be able to recognize the patient presenting with cervical spine trauma, prioritize the care for this p atient, perform adifferential diagnosis, and initiate appropriate and immediate therapeutic interventions.

9. Function as assistant in neurosurgery commensurate with ones level of education.

10. Identify the patient that requires a referral to a neurosurgeon.

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