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Electives - General Surgery

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ACE - A. I. in General Surgery - Red Service

Elective Number: (Oasis E76r) 3024

Course Director: Philip W. Smith. MD
Attendings: Martha A. Zeiger, MD and John B. Hanks, MD

Coordinator: Heather Trainum
Duration: Maximum 4 weeks, Minimum 2-weeks (which is a non-ACE option)
Available: all Rotations

Report to: Red Surgery Chief (PIC#1353)
Time to Report: As designated by Red Surgery Chief
Place to Report: As designated by Red Surgery Chief
Typical day: 6:40 am - 6:00 pm
Attendance: A student may not take time off during an ACE.
Attendance at elective activities is mandatory.

Number of students per rotation: 1 
Course Description: The Red surgery service is primarily responsible for the care of patients with endocrine disorders amenable to surgical therapy. Drs. Zeiger and Smith are the clinical endocrine surgery attendings and primarily manage patients with thyroid, parathyroid, and adrenal disorders. Dr. Smith also participates in general surgery call, and patients from night and weekend call may be cared for under the umbrella of the Red Surgery Service. Dr. Hanks has retired his clinical practice. Among his roles as a Professor Emeritus is participation in Red Surgery education conference aka “Red Book”. Residents assigned to this service will include a PGY-4 (Chief), and a PGY-1 resident. The PGY-1 resident has co-responsibility for the Red and Green Surgery services, and active participation of the ACE should fulfill the majority of the PGY-1 intern duties. Dr. Smith will review this course description and expectations with you in person at the beginning of your rotation. Dr. Smith will also provide a mid-clerkship, and end of clerkship feedback session.

Learning Objectives
Upon completion of this rotation the medical student should be able to:

1. Describe the evaluation and initial management of a patient presenting with
a. a solitary thyroid nodule. 
b. hypercalcemia in the setting of primary hyperparathyroidism. 
c. CT scan finding of unilateral incidental adrenal mass.

2. Demonstrate the ability to function as the operating surgeon with direct assistance by Dr. Smith and/or chief resident in thyroid and parathyroid procedures for the steps of  
a. patient positioning
b. surgical site preparation
c. skin incision
d. creation of sub-platysmal plane
e. opening of strap muscles
f. closure of strap muscles
g. closure of platysma
h. closure of skin.

3. Demonstrate the performance of the steps of a thyroid ultrasound on a patient in the operating room.

4. Demonstrate the ability to enter post-operative orders and discharge orders for patients with a typical course following cervical endocrine procedures. 

5. Detect the clinical presence or absence of the bedside clinical signs of post-cervicotomy hematoma, hypoparathyroidism, and vocal cord paralysis and appropriately document these in oral presentation and progress notes.

6. The student will demonstrate the qualities of commitment, trustworthiness, integrity, compassion and respect of the patient’s autonomy, confidentiality and need for information.  The student will demonstrate professional attributes with regard to professional responsibility.

Responsibilities

The ACE should participate in all service activities. These include:

1. Attend clinic for the preoperative and postoperative care and evaluation of patients.  

2. Be involved in the care of inpatients on the Red Surgery service. You are expected to be involved in the ongoing care of any patient in whom you were involved in the admission or operative care. You should perform post-operative checks and morning rounds . This includes seeing the patient, reviewing appropriate laboratory and study data results, reporting the status of each patient and their studies to the chief resident on rounds, and writing a progress note in Epic using the appropriate student notes. You should manage wound care under the guidance of the residents and faculty on service. 

3. For typical patients following cervical endocrine procedures, you should enter the post-operative orders and the discharge orders using the defined order sets specific to the service. The residents will review and cosign these orders as appropriate. 

4. Be involved in the operative care of patients on the service. You should be completely prepared for every OR case prior to scrubbing in. This means that you have reviewed the patient's history and know the results of all laboratory, radiology and pathology studies. In addition, you are expected to read about the patient's disease process, the treatment options, and the details of the proposed surgery, including relevant anatomy and the surgical techniques involved. As you demonstrate aptitude, you will be granted progressive operative involvement up to the steps described in learning objective two (above). If you have not been provided the planned elective OR schedule, contact Alisha Wright RN who will provide this to you.

5. Prepare a presentation on a topic of your choice. This should be based on a clinical question that you encounter during the first two weeks on service. The presentation should be a literature based attempt to answer the question that you encountered, and not a “textbook chapter” review. The presentation length should be approximately ten minutes, or less. The chief resident and faculty can provide guidance on a topic and will arrange a time for presentation. 

6. Run the weekly “Red Book” conference which occurs on a weekly basis. This includes collecting the pathology results for the previous week. The chief resident, faculty, and the prior ACE (if one was on the rotation prior to you) will guide you regarding this endeavor. 

7. For the 3rd and 4th weeks on service in Dr. Smith’s weekly clinic, the ACE should
a. Perform, present, and document at least one complete History and Physical for a pre-operative thyroid surgery patient, and at least one complete History and Physical for a pre-operative parathyroid surgery patient.
b. evaluate, present, and document at least one post-operative thyroid surgery patient, and at least one post-operative parathyroid surgery patient
c. seek feedback from Dr. Smith regarding the above. 

8. If Dr. Smith is on general call on a weeknight, the ACE should take call that night, and report to the General Surgery Consult resident (PIC 1305) at the completion of the daytime elective clinical activities. The ACE should participate in rounds on any Red inpatients on those weekends that the Red Surgery intern is NOT on call and the service is being cross covered by an off-service intern. The ACE will report to the intern and senior resident covering the service on those days (PIC 9270 and PIC 1353). If there are no patients in the hospital on the Red Surgery service (most weekends), the ACE is not required to be in the hospital. The ACE is off on weekends that the service is being covered by the weekday Red Surgery intern.

9. If another ACE will be rotating on Red Surgery following your rotation, you are expected to provide “sign out” to the incoming ACE to assist in them assuming your responsibilities / opportunities on the service.