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Clerkship - Surgery
Salem Veterans Affairs Medical Center
Students on the surgical clerkship at the VA Medical Center spend five
weeks at the Salem VAMC.
While at the Salem VAMC, the students are an integral part of the medical
team under the supervision of the residents and the attending staff. They
are expected to present patients to the residents at the morning rounds
and then go to the operating room if any of the patients they have worked
up are being operated upon or if there is a particularly interesting procedure
being performed. If not assigned to the operating room, or a specific
program for the morning, they are expected to take care of patients on
the inpatient wards or go to the outpatient clinic to work with the attending
and the residents there. Except on holidays, students are expected to
be on the wards for morning rounds at 7:15 a.m. and participate in all
ward activities until 6:00 p.m., at which time they may leave. The rotation
ends on the last Friday at noon, if there are no examinations in Charlottesville.
In case of examinations, the rotation ends at noon of the last Thursday.
Ambulatory care training is emphasized during the Salem VAMC rotation.
Each student has a day assigned to the Surgical Outpatients Clinic. Students
are also assigned a day each week to work in the Day Surgery Department.
Usually there are scheduled lectures and demonstrations after lunch each
working day as listed on a timetable given to students at their initial
interview. These have priority and, therefore, it is the responsibility
of the student to inform the attending when the student assists in a case
in the operating room so that he/she can be relieved to attend the lectures
at the given time. The lecture schedule covers the items being discussed
didactically in Charlottesville during the same period. Added to this
are a number of extra topics that we feel should be discussed with the
The students also are trained in the endotracheal intubation by first
practicing on a mannequin and then intubating suitable patients under
appropriate supervision. Students go to the Radiology Department on assigned
mornings to observe the radiologist perform diagnostic procedures that
are commonly performed on surgical patients. Two special lectures covering
Radiology of the abdomen and chest are scheduled. In addition, students
are scheduled to observe a Nuclear Medicine procedure. A special lecture
is given on the use of parenteral nutrition, central and peripheral, on
There are a number of conferences, particularly the Medical-Surgical
Chest Conference, the meetings of the Tumor Board and the Thursday Surgical
Staff Meeting and Mortality Morbidity Conference. These are listed on
the schedule and the students are required to attend these and present
cases if and when desired.
The students are assigned night call and weekend call in rotation and
are provided with a pager so that they can be informed of activities on
the service. The students who are not on call are welcome to participate
in ward activities outside duty hours but are not obligated to do so.
A mid-term evaluation is held by the Chief Surgical Resident during the
third week of the rotation. There are no examinations while at Salem;
however, the grading for ward work is done by the attending staff and
the Chief Resident by discussion. The grading is based on knowledge and
performance, the ability to cooperate with others, the ability to present
cases, the attitude toward patient care and learning at the bedside. The
evaluation is on the same standard form used by the Department of Surgery,
UVA Health Sciences Center, Charlottesville, VA.
There is an on-going dialogue between the students and attending staff
so that the teaching program can be implemented when appropriate. As part
of this dialogue, an exit interview is held, individually, with each student
and Dr. Wayne Wilson on the last day of their rotation.
Dr. Wayne Wilson, Chief, Surgery, (540) 982-2463, ext. 2674