This eight-week clerkship is designed to train students to recognize physical conditions and disease processes that represent surgical emergencies, to provide an understanding of when surgical consultation is appropriate for patients and to introduce the student to the principles of surgery as practiced by all surgeons regardless of specialty. The clerkship is administered by the clerkship directors as an interdepartmental effort of the departments of Surgery, Orthopedic Surgery and Urology.
During the clerkship, the student will have a four-week rotation in abdominal surgery and a four-week, in-depth "selective" subspecialty experience. Students can be assigned to NMH, Lurie Children's Hospital or the VA during the clerkship.
The didactic curriculum that supplements the clinical experiences includes a series of presentations on Wednesday and Friday afternoons. There will be interactive sessions, physical exam sessions, case-based sessions and lectures. Students also participate in faculty-led seminars that cover topics affecting surgeons in all specialties. Small-group skills sessions are led by our nurse educator during the clerkship. Complementary experiences include a suture and tubes and drains session during orientation, an OR Simulation during orientation, IV/ABI skills instruction, an online learning module for order writing and a discussion on ethics in surgery.
Program Objectives (Competencies)
Clerkship Goals & Objectives
At the end of the four-week experience, students will be able to do the following:
- Demonstrate proficient history-taking and physical examination skills
- Develop and discuss appropriate patient care plans
- Work up and manage common postoperative complications
- Develop appropriate management plans for patient complaints
- Properly counsel patients and obtain proper surgical consent
- Present a clinical case scenario reflective of adaptive thinking
- Demonstrate professional communication skills utilizing SBAR methodology
- Demonstrate skills in appropriately handing off care of patients
- Behave with honesty, integrity, respect and compassion toward all patients, families, allied health professionals and colleagues
- Ask for and give appropriate and timely feedback to team members in a non-confrontational or non-defensive manner; demonstrate ability to create a well-articulated plan for improvement
- Perform appropriate wound care for patients
- Demonstrate mastery level performance on knot tying, suturing, chest tube insertion (mannequin), central line insertion (mannequin), performing the FAST exam
Find comprehensive Surgery Clerkship Goals and Objectives.
Assessment & EPAs
Clerkship Assessment & Grading Policy
I. Grading Policy for the Surgical Clerkship
Possible grades for the Surgery Clerkship are Honors, High Pass, Pass, Fail, and Incomplete. The cutoff score for each grade is set annually based on national standards and program evaluations.
Your clerkship grade will be derived from the following components:
% (or points)
towards final grade
Faculty/resident clinical performance assessment (CPA)
Computer Based Clinical Assessment (CBCA)
10 (based on P/F)
Professionalism and Participation
A. Clinical Performance Assessment (CPA) (35%)
A total of 5-6 CPAs are required for the clerkship. For the 4 week rotations, 3 CPAs are required; one from an 1) attending, 2) fellow or senior resident and 3) junior resident. For the 2 week rotations, 1 CPA is required from an attending.
Surgical faculty and residents will evaluate students in writing at the end of the assigned rotation. When completing the CPA, the faculty and resident will consider all aspects of clinical performance and are asked to remark on areas of strengths, areas needing improvement and overall performance. You will be assessed based on your demonstrated competency with the following Entrustable Patient Activities (EPAs):
EPA 1: History taking and physical exam
EPA 2: Clinical reasoning, differential diagnosis, application of fund of knowledge
EPA 5: Oral presentation of patient
EPA 6: Written Notes
EPA 7: Medical decision making and incorporation of the literature
EPA 9: Contributes as a member of the team
Notes on Clinical Performance Assessments:
- There are times when exposure to the attending physician or the assigned resident has been limited. In these situations, you may request the CPA be completed by the preceptor with whom you are working most closely. In this case, please request this change via email to both the clerkship director and coordinator. This should be a rare request.
- While some CPA assessment ratings will be based on direct observation of the skill, faculty and residents will use a variety of different inputs to inform their summative assessment including but not limited to work products (such as oral presentations or written notes) or discussion with team members.
- The clerkship coordinator will distribute the CPAs to the preceptors at the conclusion of each rotation.
- There are occasions in which the overall clinical grade is impacted by inconsistent evaluations, concerning patterns of feedback, professional issues, etc. The clerkship Grading Committee team is aware of the limitations of an individual assessment and employs a system of assessment utilizing multiple reviewers and data points to help minimize the impact of one specific assessment. The Grading Committee reviews evaluations as a whole to take these issues into consideration giving the student the benefit of the doubt when one specific assessment may be an “outlier”.
B. Objective Structured Clinical Exam (OSCE) (20%)
The surgery OSCE is an objective assessment of your ability to integrate the skills, attitudes and clinical information presented during the clinical clerkship. The OSCE is a series of simulated scenarios where Standardized Patients (SP) present surgical issues that are covered during the surgical clerkship. The OSCE is designed to evaluate your ability to gather clinical data and to diagnose clinical problems. In this practical exam, you will interview and/or examine SP’s and follow-up with computer prompted questions related to the simulated experience. There are three patient scenarios. Your score will be based on your ability to express relevant information from the patient, formulate a differential diagnosis and develop a basic management plan. Each patient care simulation is standardized for all students.
C. Computer Based Clinical Assessment (CBCA) (20%)
CBCAs are similar to OSCEs as they are designed to assess surgery clerkship students’ ability to properly evaluate and treat surgical patients with common surgical disease processes except there is no SP. Assessment components include ability to develop a differential diagnosis on patient history and physical exam, order purposeful labs and imaging based on the differential diagnosis, interpret labs in the context of the differential diagnosis, interpret basic imaging in the context of the differential diagnosis and demonstrate clinical reasoning/development of a treatment plan based on history, physical exam, labs and imaging. There will be 3 CBCAs scenarios.
D. NBME Subject Examination (15%)
The NBME Shelf Exam is a 110-question multiple choice written examination that will test your knowledge of surgical diseases and treatments. It reflects the content of the USMLE Step II Clinical Knowledge examination. Questions on the written examination are not based on specific individual lectures directly, but rather on topics within the broad field of general surgery and sub-specialties including material on the presentation, pathophysiology, and management of common surgical problems.
This exam is administered on the final day of the clerkship and is 2 hours and 45 minutes long. The Clerkship Knowledge Objectives, which can be found on EMERG and CANVAS, should be used to serve as a guide for studying.
The NBME is scored as pass/fail. The passing score cutoff is set by the NBME as the Hofstee score. For the 2020-2021 academic year, the passing score was score of 61 or higher.
If the NBME exam is failed, then the highest grade that the student can receive for the clerkship is Pass. If failed, the exam will need to be retaken and passed.
Per FSM policy:
“The passing score for NBME subject examinations in Phase 2 and 3 clerkships is set at the most recent
Hofstee recommended passing score from the NBME."
If the student fails the NBME Subject Examination but has completed all the other requirements of the clerkship, the final clerkship grade is an Incomplete. The student will be referred to the Associate Dean for Student Affairs and the Director of Academic Success to create a learning plan and will be provided resources for study skills as indicated. The student must retake the examination within six months of completing the clerkship, unless otherwise approved by the Associate Dean for Student Affairs. The student must provide their desired retake date to the clerkship director at least two weeks in advance.”
E.Professionalism and Professionalism: (10%)
Professionalism is an integral part of the Surgical experience. Students are expected to demonstrate honesty, integrity, respect, and compassion in all interactions with patients, peers, faculty, staff, and other health care professionals in all settings. Your professionalism is assessed as part of the clinical interaction with patient and team members, as well as part of specific behaviors that indicate consideration and accountability throughout the clerkship.
Each student can earn the maximum 10 points during the clerkship through the following practices:
- Care of equipment - Returns suture kit by end of rotation, kit is cleaned of all suture and sharps are properly contained. 1 point
- Prompt attendance and participation in PBL and teaching sessions– 2 points
- Updated clerk-log – Clerk-logs must be updated weekly; the logs will be checked to assure compliance- 2 points.
- Orientation and skill sessions - Prompt attendance and participation in practical and didactic sessions. 2 points
- Prompt attendance to mid-clerkship conference - 1 point
- Professional demeanor when working with colleagues and educators. – 2 points
II. Calculation of Final GradesA. Standard Setting:
The Surgical Clerkship Grading Committee is made up of the core administrators of the Surgical Clerkship along with physician representatives from Subspecialty rotations. At the start of each academic year, this committee and AWOME representatives review outcomes, grades, assessment tools and annual report from the NBME to set the criteria for the rankings of Honors/ High Pass/ Pass/Fail.
B. Calculating Grades
The grades are determined by the total number of points based on the assessment elements as listed above: CPAs, OSCE, CBCA, NBME subject exam and Professionalism and Participation. The Surgery Faculty Grading Committee will evaluate all components of the student’s performance to determine the final grade. The Grading Committee and clerkship leadership will discuss students whose scores fall below the cut point for pass/fail and prescribe a remediation plan.
*Students below the pass cut point will receive a Requires Extra Time grade and a remediation plan will be determined by the clerkship director. This may include remediation of a proscribed amount of time. The amount of time needed will vary. After successful completion of the remediation plan the grade will be “Pass” and the number of additional weeks needed will be noted on the transcript.
** A grade of fail will be given in any of the following circumstances.
- Failing the NBME shelf exam three
- Being unable to meet the clinical requirements of the clerkship after completing additional time
- An egregious professionalism
Summative evaluations (grades and comments) are reported to the Feinberg School of Medicine Office of Medical Education six weeks following the end of the clerkship.
Mobile Observations – This assessment tool is designed to provide the student with formative feedback. They can be obtained throughout the entire rotation. Students must obtain five (5) completed mobile observation forms over the entire clerkship. One submitted mobile observation must be an EPA 1 (Observed History and Physical Exam) to fulfill your Direct Observation of a History and Physical Exam requirement. The Mobile Observations are not calculated directly into the student’s overall grade. However, written feedback on the Mobile Observation can be used for the MSPE Summative Assessment and may be used to improve a students’ grade if the narrative supports higher performance for a student who is on the borderline for a specific skill.
Required Clerkship Clinical Experiences (Clerklog) & Tools
- Download the Clerkship clerklog
- Access the Clerklog Online (requires NetID)
Policies & Procedures
For Faculty & Residents
- Safe and Healthy Learning Environment
- Medical Student Supervision and Level of Responsibility Policy
- Duty Hours Policy
- Assessment and Health Providers Policy
- Non-Discrimination Statement
- Non-Retaliation Policy
- Assessment Policy for Clerkships & Electives (Phases 2 and 3)
- Visiting Resident Policy
- Phases 2 and 3 Attendance Policy and Procedure
- Patient Caregiver Preferences and Refusal of Care by Caregivers Policy
- Performing Sensitive Physical Exams Policy
- Needle Stick and Other Blood-Borne, Body Fluid and or Respiratory Pathogen Exposure Policy