The surgery subinternship is designed to help students acquire the cognitive, technical and communication skills needed for the first year of residency, regardless of the specialty. While the clinical experiences encountered during the rotation primarily involve surgical disease, the rotation itself emphasizes the multidisciplinary and collaborative nature of the modern approach to patient care that ensures safety and optimizes outcomes. Students are expected to assume the same responsibilities and tasks as first-year residents.
The subinternship features hands-on experiences in these clinical tracks:
- Surgical oncology
- Colorectal surgery
- Trauma and acute care surgery
- Minimally invasive surgery
The rotation also provides three hours a week of protected time for educational activities such as case-based professor rounds and learning procedural skills under supervision. Interactive exercises such as mock-pages, web-based modules, reading assignments and short projects provide students with well-rounded experiences and skills in a high-yield, energetic and fun atmosphere.
Goals & Objectives
Detailed Goals and Objectives
Find comprehensive Surgery Subinternship Goals and 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
Assessment and EPAs
CLERKSHIP ASSESSMENT AND GRADING POLICY
Section I: Components of the grade
Your clerkship grade will be derived from the following components:
|Component||% (or points) towards final grade|
|Faculty/resident clinical performance assessment||30%|
|Doctoring Skills- Informed Consent (EPA11) and Handoff (EPA8)||20%|
|Procedural skills (Suturing, FAST exam)||10%|
Clinical Score: (30%)
This is a sum of grades provided by faculty and residents. Total score calculation will take into consideration the grades assigned, as well as the narrative comments provided with special emphasis on the following EPA: 2, 3, 4, 6, 7, 8, 9, 10, 11, and 13.
Based on the clerkship director’s assessment of rating patterns of faculty and residents, as well as other factors (e.g. professionalism issues) the clerkship director may modify the final clinical grade.
Students are expected to complete the following in a timely manner:
- A completed the clerkship logbook and workplace-based assessment forms. These include: direct observation of clinical skills, direct observation of handoff as well as direct observation of informed consent. (10%)
- Web-based modules on pain management, principles of wound care, and electrosurgical instruments. (5%)
- An end of rotation essay (3-5 pages) that demonstrate the student's adaptive thinking regarding the application of patient safety concepts and/or quality control systems to daily patient care practices based on the students’ own observations and experiences during the rotation. (5%)
Mock Pages: (20%)
This is a sum of score achieved during the mock page encounters conducted by the nurse educators based on management decisions and communication skills.
Doctoring Skills- Informed Consent (EPA11) and Handoff (EPA8): (20%)
Achieving or exceeding level 3 of entrustment e.g. “Can perform with indirect supervision. “
Procedural skills (Suturing, FAST exam): (10%)
Achieving mastery level performance on both tasks.
Section II: Calculation of final grades
|Requires extra time**||Below 60|
* When a numerical score falls closely between two grades, the clerkship director will evaluate all components of the student’s performance to determine the final grade.
** Occasionally a clerkship director will decide a student needs additional time on the clerkship to meet the objectives. The amount of time needed will vary. In this case, 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 the following circumstances.
- Being unable to meet the clinical requirements of the clerkship after completing additional time twice.
- An egregious professionalism issue.
Honors student is one who:
- Consistently performs thorough work-ups on even the most complicated patients. This includes eliciting pertinent information unprompted, and being able to clearly present the cases in a concise and logical manner.
- Demonstrates comprehensive physical examination skills. They should have the proper techniques and be able to perform a focused abdominal examination.
- Formulates a well thought out and broad but relevant differential diagnosis and thorough treatment plan, even on complex surgical patients.
- Reads independently and uses the literature and point of care decision support resources ahead of presentation to support their plans and their thinking.
- Is independent and proactive in the execution of their patient care duties.
- Consistently demonstrates initiative in caring for their patients.
- Assimilate well in the care team and seen as dependable and trustworthy to perform assigned tasks without prompting.
- Is professional, courteous and has excellent interpersonal skills with consistent strong work ethics.
High Pass student is one who:
- Performs thorough work-ups on common, patients. This includes eliciting pertinent information, and being able to clearly present the cases in a concise and logical manner. May require occasional prompting.
- Formulates a relevant differential diagnosis and thorough treatment plan on all routine and some/ most surgically complicated cases. They may occasionally need direction and prompting to reach their goal on complex cases. But they take the initiative to do so.
- Demonstrates above average physical examination skills. They are thorough with the techniques and are able to perform a focused examination. They may occasionally miss findings.
- Consistently formulates a well thought out differential on all of the common diagnoses, and occasionally on the complex cases.
- Shows that they are reading independently and have an above average knowledge base in neurology.
- Consistently demonstrates initiative in caring for their patients and is independent and proactive in the execution of their daily patient care duties. They may occasionally need direction in performing their duties.
- Is professional, courteous and has above average interpersonal skills with very good work ethics.
Pass student is one who:
- Produces complete work-ups and elicits pertinent information on most routine cases.
- Is able to formulate a relevant differential diagnosis and treatment plan on routine cases. They may occasionally need guidance and prompting.
- Demonstrates average physical examination skills. They should be familiar with the examination techniques, and should be able to perform a focused examination most of the time, occasionally needing guidance.
- Is able to formulate a well thought out differential diagnosis on routine cases, occasionally needing guidance.
- Demonstrates that they are reading and have an average knowledge base.
- Is an independent worker, but may need prompting and direction to understand their daily duties.
- Is professional and courteous with average interpersonal skills and good work ethics.
A student who requires extra time is one who:
- Is unable to complete work-ups or elicit pertinent information on routine surgical cases.
- Is unable to formulate a relevant differential diagnosis and treatment plan on routine cases, even with prompting and guidance.
- Is unable to perform physical examination and is unfamiliar with the proper examination techniques.
- Demonstrates an extremely poor knowledge base.
- Is unable to perform daily clinical care duties, despite regular prompting and guidance.
- Demonstrates unethical or unprofessional behavior. Other professional grounds for failing include dishonesty, unexcused absences or poor work ethics including willful negligence in patient care duties.
Required Clerkship Clinical Experiences (Clerklog) and additional tools
Policies and Procedures
- 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