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Electives - General Surgery


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

Elective Number: (Oasis E76r) 3024

Course Director: Philip W. Smith. MD

Attending: John B. Hanks, MD

Coordinator: Heather Trainium

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:

Course Description: The Red surgery service is primarily responsible for the care of patients with endocrine disorders amenable to surgical therapy. Dr Smith is the endocrine surgery attending and primarily manages patients with thyroid, parathyroid, and adrenal disorders. Dr. Smith also has a practice in the care of melanoma and other cutaneous malignancies, which also are 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. 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.

Learning Objectives
Upon completion of this rotation all medical students 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. a CT finding of unilateral incidental adrenal mass.

2. Demonstrate the ability to function as the operating surgeon with direct attending and/or chief resident assistance in a cervical endocrine procedure for the steps of incision, creation of sub-platysmal plane, opening of strap muscles, closure of strap muscles, closure of platysma, and closure of skin.

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

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

1. Attend clinic for the preoperative and postoperative care and evaluation of patients. Dress professionally for clinic.
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 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 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 learning objective two (above). If you have not been provided the planned elective OR schedule, contact Ginny Simpson NP who will provide this to you.
5. Prepare a presentation on a topic of your choice. This should be based on a 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. The chief resident and Dr. Smith can provide guidance on a topic and will arrange a time for presentation.
6. Run the weekly “Red Book” conference which occurs on Wednesday after clinic. This includes collecting the pathology results for the previous week. The chief resident and Dr. Smith will guide you regarding this endeavor.
7. For the 3rd and 4th weeks on service in the weekly clinic, the ACE should
a. Perform, present, and document at least one complete History and Physical for a pre-operative patient.
b. evaluate, present, and document at least two post-operative patients
c. seek feedback from Dr. Smith regarding the above.