THE UNIVERSITY OF WASHINGTON THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINESCHOOL OF MEDICINE

PREPARING FOR THEPREPARING FOR THETHIRD-YEAR STUDENT THIRD-YEAR STUDENT

CLERKSHIP IN SURGERYCLERKSHIP IN SURGERY

Roger P. Tatum, MDRoger P. Tatum, MDAssistant Professor of SurgeryAssistant Professor of Surgery

Director of Medical Student Surgical EducationDirector of Medical Student Surgical Education

November 25, 2008November 25, 2008

ObjectivesObjectives1.1. demonstrate a method of focused evaluation and workup of demonstrate a method of focused evaluation and workup of

the surgical patientthe surgical patient

2.2. Identify what constitutes appropriate surgical referralIdentify what constitutes appropriate surgical referral

3.3. Perform a thorough abdominal examPerform a thorough abdominal exam

4.4. Identify the important factors in the diagnosis, workup, and Identify the important factors in the diagnosis, workup, and management of various specific surgical problemsmanagement of various specific surgical problems

5.5. Perform some basic surgical techniquesPerform some basic surgical techniques

Structure of ClerkshipStructure of Clerkship

Each student will be Each student will be assigned to a surgical team assigned to a surgical team or group of surgery or group of surgery attendingsattendings

Average day will consist of Average day will consist of am rounds, followed by am rounds, followed by OR or clinic, conference(s), OR or clinic, conference(s), and (likely) evening roundsand (likely) evening rounds

Requirements of the ClerkshipRequirements of the Clerkship

Clinical GradeClinical Grade: a combination : a combination of your performance on the of your performance on the wards with the residents and wards with the residents and attendings, as well as the attendings, as well as the patient write-ups and patient write-ups and literature reviewliterature review

Being present in clinic, on the Being present in clinic, on the wards, and in the OR is wards, and in the OR is essentialessential

Enthusiasm goes a long way!Enthusiasm goes a long way!

Requirements of the ClerkshipRequirements of the Clerkship

Final ExamFinal Exam: : Given the last day of the rotationGiven the last day of the rotation Multiple-choice standardized examMultiple-choice standardized exam Questions will be related to topics in the learning Questions will be related to topics in the learning

objectives (on the website)objectives (on the website) Very important component of the final grade!Very important component of the final grade!

Clerkship Sites—SeattleClerkship Sites—Seattle

University of Washington Medical Center University of Washington Medical Center (UWMC)(UWMC)

Harborview Medical Center (HMC)Harborview Medical Center (HMC) VA Medical Center—Seattle (VAMC)VA Medical Center—Seattle (VAMC) Virginia Mason Medical Center (VMMC)Virginia Mason Medical Center (VMMC)

Clerkship Sites—WWAMI RegionClerkship Sites—WWAMI Region

VA Medical Center—Boise, ID (VAMC—Boise)VA Medical Center—Boise, ID (VAMC—Boise) Sacred Heart Medical Center, Spokane, WASacred Heart Medical Center, Spokane, WA Fairbanks Memorial Hospital, Fairbanks, AKFairbanks Memorial Hospital, Fairbanks, AK Missoula, MTMissoula, MT Billings, MTBillings, MT Casper, WyomingCasper, Wyoming Madigan Army Medical Center, Fort Lewis, WAMadigan Army Medical Center, Fort Lewis, WA

Clerkship SitesClerkship Sites

Each site is different in terms of the variety of Each site is different in terms of the variety of patients and cases seenpatients and cases seen

Lectures are available on-line for WWAMI sitesLectures are available on-line for WWAMI sites

Seattle sites may be best (especially UWMC, HMC, Seattle sites may be best (especially UWMC, HMC, and VAMC) for students interested in Surgery as a and VAMC) for students interested in Surgery as a careercareer

5-6 students5-6 students Tertiary referral Tertiary referral

center—typically center—typically more complex or more complex or advanced cases, as advanced cases, as well as some more well as some more common surgical common surgical problemsproblems

UWMCUWMC

5-6 students5-6 students Trauma center—high Trauma center—high

volume of blunt and volume of blunt and penetrating trauma cases penetrating trauma cases (call can be very busy), (call can be very busy), some routine and some routine and advanced general advanced general surgery, less surgical surgery, less surgical oncologyoncology

HarborviewHarborview

3-4 students3-4 students Tertiary referral center for Tertiary referral center for

VA systemVA system Wide variety of general Wide variety of general

surgery cases, many surgical surgery cases, many surgical oncology cases, less oncology cases, less emergency cases emergency cases

No traumaNo trauma Predominantly male Predominantly male

populationpopulation

VAMC—SeattleVAMC—Seattle

2 students2 students Wide variety of general surgery cases, many more Wide variety of general surgery cases, many more

complex casescomplex cases No traumaNo trauma

VMMCVMMC

1-2 students1-2 students More of a community More of a community

general surgery experience, general surgery experience, less of the complex casesless of the complex cases

Students are more Students are more independent—no residents independent—no residents at these sitesat these sites

Boise, Spokane, and FairbanksBoise, Spokane, and Fairbanks

1 student1 student community general surgery community general surgery

experienceexperience Students will be independent—Students will be independent—

no residentsno residents Apprentice-style learningApprentice-style learning Abundant outdoor recreation Abundant outdoor recreation

(skiing, hiking, (skiing, hiking, et alet al.).)

Missoula, MontanaMissoula, Montana

1 student1 student community general surgery community general surgery

experience with 2 groups of six experience with 2 groups of six surgeons each; includes traumasurgeons each; includes trauma

Family Practice residency on-Family Practice residency on-sitesite

Mid-sized community with Mid-sized community with numerous resourcesnumerous resources

Abundant recreationAbundant recreation

Billings, MontanaBillings, Montana

1 student1 student community general surgery community general surgery

experience with high-experience with high-volume surgeons; includes volume surgeons; includes traumatrauma

Family Practice residency Family Practice residency on-siteon-site

Casper, WyomingCasper, Wyoming

1-2 students1-2 students Broad range of Broad range of

general surgery and general surgery and sub-specialtiessub-specialties

Surgery residency Surgery residency training site—training site—student will be on a student will be on a surgical servicesurgical service

Madigan Army Medical CenterMadigan Army Medical Center

SURGERY CLERKSHIPSURGERY CLERKSHIPClerkship SitesClerkship Sites

Check the Surgery Clerkship website (Check the Surgery Clerkship website (http://depts.washington.edu/surgstus/CLERKSHIP/first.html) at least 3 weeks prior to starting the clerkship for ) at least 3 weeks prior to starting the clerkship for information specific for your site—you will need to information specific for your site—you will need to submit information to the site coordinatorsubmit information to the site coordinator