SELECT SISRA - Inpatient Acting Internship in Surgery

Chiranjiv Virk, M.D. (vascular)

Navdeep Samra, M.D. (trauma)

Terry Lairmore M.D. (surgical oncology)

Keith White, M.D. (cardiothoracic surgery)

Mark Brown, M.D., Donald Sorrells, M.D., Kevin Boykin, M.D. (pediatric surgery)
Administrative Contact: Debbie Thornhill Phone: 675.6126 Room: 3-303
4 Credits

COURSE A (Elective Surgery)

DIRECTOR: John Savoy, M.D.
SELECTIVE DIRECTOR:   Arielle DuBose, M.D., 675.6126, Room 3-303
ADMINISTRATIVE CONTACT: Debbie Thornhill, 675.6126, Room 3-303
LOCATION: Academic Medical Center at Ochsner LSU Health Shreveport  , VA Hospital - Shreveport,  Monroe Medical Center at Ochsner LSU Health Shreveport (elective surgery)
NUMBER OF STUDENTS PER 4 WEEK BLOCK:  3
SELECTIVE AVAILABLE DURING BLOCKS:    All
COURSE CODE: SISRAA
 
Primary Goals
The student will:
1.  Obtain a more advanced understanding of surgical disease processes and treatment.
2.  Obtain more advanced experience in assessment and diagnosis of surgical disease processes
3.  Obtain experience in graduated responsibility as an acting intern on an inpatient service.
 
Specific Objectives
The student will:
 1.  Obtain experience in taking a history and performing a problem-focused physical examination on the wards and in clinics.
2.  Formulate a differential diagnosis in clinic and on the wards, adding emphasis to assessment and plan.
3.  Obtain experience in the performance of basic surgical skills in the operating room and clinics.
4.  Obtain experience in surgical decision making with attending supervision in and out of the operating room.
5.  Practice interpersonal and communication skills during interactions with patients, families, and health care teams.
6. Formulate a case log and enter it into a word document. The log must include at least 15 cases. Each case logged must include a brief but informative review of the case, a list of what has been learned, and a review of at least one article. The log is submitted to Ms. Thornhill at the end of the rotation.
 
Resources for Learning
Participating faculty:  Surgical faculty
Texts: Lawrence, Essentials of General Surgery
Hands-on Experience: Wards, OR, and clinics
Directed Readings: According to cases seen
Self-Directed Learning: Case studies
 
Formative Evaluation
 At the beginning of the second week of the elective, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up a Formative Evaluation Form and expedite completion.  Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. DuBose will accommodate.
 

Outcome and Evaluation Measures (Grades)
Students will receive a grade of pass (P) or fail (F). No student will receive a pass (P) without completing the log requirements.  At the end of the course, the course director will review the student’s log and performance. No student will receive a pass (P) without completing the log requirements. Performance will be judged on the basis of knowledge, skill, and professionalism. Professionalism will be measured in terms of punctual attendance, maturity, interpersonal and communication skills, approach to the patient, and interaction with faculty and other staff.

COURSE B (Surgical Oncology)

SELECTIVE DIRECTORS: Terry Lairmore, M.D.                                                                         
ADMINISTRATIVE CONTACT: Debbie Thornhill: 675.6126
DURATION OF ELECTIVE: 4 Weeks
LOCATION OF ELECTIVE: Academic Medical Center at Ochsner LSU Health Shreveport  
MAXIMUM NUMBER OF STUDENTS:  2
ELECTIVE OFFERED DURING BLOCKS: All Blocks
Course Code:  SISRAB

 GOALS
 Learn to perform a thorough Oncology exam
Develop an understanding of the preoperative evaluation of Oncology patients, including preoperative staging of tumors, evaluation of co-morbidity, determination of the role of surgery and preoperative optimization for surgery.
Develop an understanding of the likely outcome of surgical oncology treatments
 
OBJECTIVES
The student will scrub in on operative cases and examine, work-up and preoperatively prepare patients for surgery and other treatments.
The student will postoperatively manage the care of patients that includes the care of the sequelae and complications .of surgical interventions
 
SPECIFIC DUTIES OF SENIOR STUDENTS
 
• Written work-ups of patients assigned to senior student
• Present work-up patients to senior resident/staff
• Participating in surgery cases (scrubbing in) on patients he/she worked up
• Participating in/performing certain procedures on patients on service (e.g. placing and removing chest tubes, central lines, arterial lines, some suturing (under supervision)
• Participating as a “junior intern” in daily service rounds including SICU and including the writing or progress notes and orders (under supervision) (co-signed by resident or staff) and perform daily post-op exams, dressing change.
• Participate in weekend ward rounds on at least one day of each weekend while on service
• Participate in Oncology Clinic and outpatient evaluation of patients
 
READING ASSIGNMENTS
 
• Chu QD, Gibbs J, Zibari G. Surgical Oncology: A Practical and Comprehensive Approach. Springer 2014.
• Participation in Multidisciplinary Tumor Board and discussion on multimodality approach to the treatment of cancer, including expected treatment outcome.
 
FORMATIVE EVALUATION

At the beginning of the second week of the elective, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up a Formative Evaluation Form and expedite completion.  Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. DuBose will accommodate.

OUTCOME AND EVALUATION MEASURES

At the end of the course, the course director will submit an evaluation of the student’s performance. It will include references to knowledge, skill, and professionalism. Professionalism will be measured in terms of punctual attendance, maturity, approach to the patient, and interaction with faculty and other staff.

Course C (Trauma, Acute Care Surgery & Surgical Critical Care)

SELECTIVE DIRECTOR(S): Navdeep Samra , M.D.    
ADMINISTRATIVE CONTACT: Debbie Thornhill    318.675.6126
DURATION OF ELECTIVE: 4 Weeks    
LOCATION OF ELECTIVE: Academic Medical Center at Ochsner LSU Health Shreveport  
MAXIMUM NUMBER OF STUDENTS:  4    
ELECTIVE OFFERED DURING BLOCKS:  All
COURSE CODE: SISRAC

GOALS
• To become familiar with the initial evaluation of the trauma patient in the emergency room, as well as the principals of resuscitation and stabilization.
• To become familiar with general principals of both operative and non-operative management of the trauma patient.
• To become familiar with principles of surgical critical care.
• To provide additional experience for senior students considering the pursuit of a surgical career.
• To learn how to manage mechanical ventilators, the use of hemodynamic monitoring and optimization in various forms of shock including septic and hemorrhagic shock.
• To gain facility with overall evaluation and management of all systems and function of critically ill patients including nutrition, fluid maintenance, and electrolyte balance.
• To understand the principles of the physiological response to stress and its application to the support of the critically ill.
OBJECTIVES
 The student will participate as an active intern in the pre-operative, intraoperative, and post-operative care of the patients of the trauma service under the supervision of the house staff and trauma staff.
• Student will make rounds on surgical critical care service daily
• Student will participate with intern in consultations, orders, and other chart review
• Student will act independently in critical assessment and plan initiatives
• Student will participate in line placement and other invasive procedures
• Student will document daily activities, learning events, and self-directed learn activities in a diary for review by Dr. Samra
• Student will meet with Dr. Samra before beginning the course, again at the halfway point, and again at the end for clarification and feedback

SPECIFIC DUTIES OF SENIOR STUDENTS
•   The senior student will be the acting intern assigned to specific patients on the trauma service, de- pendent upon his/her desires and abilities with supervision of the house staff and trauma staff. She/he will be responsible for the new work-up, pre-operative, post-operative care of these patients.
• The student will take call with the intern on the trauma team, and is expected to participate in all trauma surgery taking place on his call nights.
• The student is expected to take call on any day that the intern is on call, even when it falls on a weekend. If the weekend has no call for the intern, the senior student may elect to take Sunday off.
• This one month rotation will be located in the University Health Hospital Surgical Intensive Care Unit or Burn Unit. The student will be an integral part of the Surgical ICU Team. She/he will be assigned responsibility for knowing all aspects of the patients assigned to them. Student will be supervised by the house staff and the staff of the division of trauma and critical care. Students will be expected to identify the patient’s problems, present these problems clearly and comprehensively and to devise a plan for addressing the problems. Also the student will participate in the procedures done in the critical care unit including the placement of central lines, Swan Ganz catheters, bronchoscopy, burn wound change, etc. The student’s hours will be exactly those of the SICU or Burn Unit residents.
 
READING ASSIGNMENTS (strongly recommended)
Reading assignments will be those pertinent to the care of the patients on the surgical service. Additionally, pertinent chapters in Schwartz or Sabiston regarding trauma should be addressed by the student while he or she is a part of the service. The student will be required to review articles in the trauma literature.
Orientation material given to incoming students describing commonly used SICU protocols and calculations.
“The SICU Book” - Paul Marino, M.D. (Williams and Wilkins)
FORMATIVE EVALUATION
At the beginning of the second week of the elective, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up a Formative Evaluation Form and expedite completion.  Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. DuBose will accommodate.
OUTCOME AND EVALUATION MEASURES
At the end of the course, the course director will submit an evaluation of the student’s diary and performance. It will include references to knowledge, skill, and professionalism. Professionalism will be measured in terms of punctual attendance, maturity, approach to the patient, and interaction with faculty and other staff. The student’s diary will contain daily entries. Entries should include references to problem solving, decision making, clinical reasoning, and communicating. Although each entry will contain different elements, entries overall must contain the patients seen, the operations seen or scrubbed for, the articles read (relate each article to a clinical encounter that led to the review and list at least two new things learned or observed,) One of the final entries must include a comprehensive review of what has been learned with specific notes relating the learning process to preparation for internship. For example, the student should have spent time learning processes like: entering orders, scheduling cases, providing informed consent, medication doses and IV fluids for acute care issues, and answering consults.
Course D (Vascular Surgery)

S
ELECTIVE DIRECTOR:  Chiranjiv Virk, M.D.                                                                         
ADMINISTRATIVE CONTACT:  Debbie Thornhill, 675.6126, Room 3-303
DURATION OF ELECTIVE: 4 weeks
LOCATION OF ELECTIVE: Academic Medical Center at Ochsner LSU Health Shreveport  
MAXIMUM NUMBER OF STUDENTS:  2
ELECTIVE OFFERED DURING BLOCKS:  All
Course Code: SISRAD

GOALS

•     To understand the etiology, epidemiology, and treatment of atherosclerotic vascular disease. Develop a working knowledge of cardiovascular risk assessment.
•     To learn the elements of and to perform a complete vascular history and physical examination.
•     To learn basic hemodynamics, ultrasound physics and noninvasive vascular laboratory investigations
•     To understand the appropriate indications for surgical in patients with Vascular disease and the appropriate treatment options
•     To understand basic vascular surgical techniques: exposure of blood vessels, suturing of blood vessels, wound approximation.
•     To understand endovascular surgery: diagnostic arteriography of the entire aorta, cerebrovascular, mesenteric, renal, and lower extremity circulation.
 
OBJECTIVES
 
Student will participate in open and endovascular procedures
Student will be assigned patients in the clinic and hospital.
Student will spend a week in the vascular lab.

ROTATION SYLLABUS

• Responsibilities of the students will be that of an acting intern, functioning as integral part of the resident team.
• Participate in all surgical and endovascular cases.
• Spend 1 week in the vascular lab gaining exposure to non-invasive test and diagnostic imaging
• Participate in vascular clinic weekly (each Tuesday)
• Participate in vascular conference weekly (mandatory attendance)
• Take call in accordance with other acting internship rotations (1 week per month)
• Active participation in small round table didactic discussions on basic vascular disease problems with our vascular team.

REFERENCE

Textbooks/Journals: Rutherford: Vascular Surgery 7th Edition
The Journal of Vascular Surgery (in the library + e-journal, monthly publication)
• Participate in vascular conference weekly (mandatory attendance)
• Take call in accordance with other acting internship rotations (1 week per month)
• Active participation in small round table didactic discussions on basic vascular disease problems with our vascular team.

 FORMATIVE EVALUATION

At the beginning of the second week of the elective, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up a Formative Evaluation Form and expedite completion.  Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. DuBose will accommodate.
 
OUTCOME AND EVALUATION MEASURES

At the end of the course, the course director will submit an evaluation of the student’s performance. It will include references to knowledge, skill, and professionalism. Professionalism will be measured in terms of punctual attendance, maturity, approach to the patient, and interaction with faculty and other staff.

Course E (Cardiothoracic Surgery)
 
SELECTIVE DIRECTOR:  Robert K. White, M.D.                                                                         
ADMINISTRATIVE CONTACT:  Debbie Thornhill, 675.6126, Room 3-303
DURATION OF ELECTIVE: 4 weeks
LOCATION OF ELECTIVE: Academic Medical Center at Ochsner LSU Health Shreveport  
MAXIMUM NUMBER OF STUDENTS: 2
ELECTIVE OFFERED DURING BLOCKS:  All
Course Code: SISRAE

This rotation is recommended for students interested in cardiothoracic and general surgery. Students not going into surgery will be allowed on the rotation at the discretion of the course director and student rotation coordinator.
 
GOALS
 
•     To understand the etiology, epidemiology, and treatment of cardiovascular and thoracic diseases. Develop a working knowledge of cardiovascular risk assessment.
•     To learn the elements of and to perform a complete cardiothoracic and vascular history and physical examination.
•     To be able to describe the basic hemodynamics and management of postoperative cardiac surgery patients.
•     To understand the appropriate indications for surgery in patients with cardiothoracic and vascular diseases and the appropriate treatment options.
•     To understand basic cardiothoracic and vascular surgical techniques: thoracotomy, median sternotomy, thoracoscopic surgery, exposure of blood vessels, suturing of blood vessels, vein harvesting, wound approximation.
•    To be able to describe the basics of cardiopulmonary bypass.

 
OBJECTIVES
 
Student will participate in open and thoracoscopic procedures.
Student will be assigned patients in the clinic and hospital.
 
 ROTATION SYLLABUS
 
• Responsibilities of the students will be that of an acting intern, functioning as integral part of the resident team.
• Participate in all surgical cases.
• Participate in cardiothoracic clinic weekly (each Friday)
• Take call in accordance with other acting internship rotations (1 week per month)
• Active participation in small round table didactic discussions on basic cardiothoracic disease problems with our team.
•    Formulate a case log and enter it into a word document. The log must include at least 10 cases. Each case logged must include a brief but informative review of the case, a list of what has been learned, and a review of at least one article. The log is submitted to Ms. Thornhill at the end of the rotation.

 
REFERENCE
 
Textbooks/Journals: Kirklin/Barrett-Boyes: Cardiac Surgery. 4th Edition.
 
 FORMATIVE EVALUATION
 
At the beginning of the second week of the elective, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up a Formative Evaluation Form and expedite completion.  Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. DuBose will accommodate.
 
OUTCOME AND EVALUATION MEASURES
 
At the end of the course, the course director will submit an evaluation of the student’s performance. It will include references to knowledge, skill, and professionalism. Professionalism will be measured in terms of punctual attendance, maturity, approach to the patient, and interaction with faculty and other staff.
 
Policies & Procedures:   http://catalog.lsuhscshreveport.edu/content.php?catoid=13&navoid=503

Course F (Pediatric Surgery)
SELECTIVE DIRECTOR:  Mark Brown, M.D., Donald Sorrells, M.D., Kevin Boykin, M.D.
ADMINISTRATIVE CONTACT:  Debbie Thornhill, 675.6126, Room 3-303
DURATION OF ELECTIVE: 4 weeks
LOCATION OF ELECTIVE: Academic Medical Center at Ochsner LSU Health Shreveport ; St. Mary Medical Center, Willis-Knighton South
MAXIMUM NUMBER OF STUDENTS: 1
ELECTIVE OFFERED DURING BLOCKS:  All
Course Code: SISRAF
This rotation is recommended for students interested in pediatric surgery, general surgery, and pediatrics. Students not going into surgery will be allowed on the rotation at the discretion of the course director and student rotation coordinator.
GOALS
• To understand the etiology, epidemiology, and treatment of pediatric surgical diseases.
• To learn the elements of and to perform a complete pediatric history and physical examination.
• To understand the anatomy relevant to common surgical diseases and surgical approaches: ie. inguinal hernia anatomy and abdominal wall anatomy.
• To understand developmental anatomy that is relevant to common pediatric surgical problems
• To understand the appropriate indications for surgery in pediatric patients and the appropriate treatment options.
• To understand basics of common surgical techniques: laparotomy, laparoscopy, inguinal hernia repair, thoracotomy, wound closure
• To learn basic care of postoperative pediatric surgery patients.

OBJECTIVES
Student will participate in open and minimally-invasive procedures.
Student will be assigned patients in the clinic and hospital.
ROTATION SYLLABUS
• Responsibilities of the students will be that of an acting intern, functioning as integral part of the resident team.
• Participate in all surgical cases.
• Participate in pediatric surgery clinic throughout the week (specific schedule will be determined by the number and complement of students and residents on the service).
• Take call in accordance with other acting internship rotations (1 week per month).
• Active participation in small round table didactic discussions on basic pediatric surgical problems with our team.

REFERENCE
Recommended Resources:
Mattei, Peter. Fundamentals of Pediatric Surgery. 2nd Edition.
Pediatric Surgery NaT. Online Resource: https://www.pedsurglibrary.com/apsa/index/Pediatric-Surgery-NaT/Disorders
FORMATIVE EVALUATION
At the beginning of the second week of the elective, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up a Formative Evaluation Form and expedite completion.  Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. DuBose will accommodate.

Course G (Breast Surgery)
SELECTIVE DIRECTOR(S): Jane Sugar, M.D.
ADMINISTRATIVE CONTACT: Debbie Thornhill, 675.6126, Room 3-303
DURATION OF SELECTIVE: 4 Weeks
LOCATION OF SELECTIVE: Academic Medical Center at Ochsner LSU Health Shreveport, Feist Weiller Cancer Center, Ambulatory Care Center
MAXIMUM NUMBER OF STUDENTS: 1
ELECTIVE OFFERED DURING BLOCKS: All
COURSE CODE: SISRAG

This rotation is recommended for students interested in Surgical Oncology, Breast Surgery, General Surgery, OB-Gyn, Radiology, and Oncology. Students not going into surgery will be allowed on the rotation at the discretion of the course director and student rotation coordinator.

Primary Goals
• To learn about the etiology, epidemiology, diagnosis, and treatment of both benign and malignant breast pathologies.
• To learn the elements of and to perform a complete history and physical examination.
• To understand the anatomy relevant to breast diseases and their surgical approaches.
• To understand common diagnostic studies related to breast imaging: ultrasound, mammography, MRI, ultrasound-guided biopsy, and stereotactic biopsy techniques.
• To learn basic care of postoperative breast surgery patients.

• To learn effective and empathetic communication techniques.

Specific Objectives
Student will see patients in Breast Surgery Clinic and participate in clinic-based diagnostic and therapeutic procedures.
Students will participate in breast surgeries.
Students will spend time with breast oncologists in an outpatient setting.
Students will spend time with radiologists reading breast imaging.
Students will spend time with pathologists analyzing breast specimens.
Students will follow breast patients through their inpatient course- both post-operative and non-operative breast patients.

ROTATION SYLLABUS
• Responsibilities of the students will be that of an acting intern, functioning as integral part of the resident team.
• Participate in all surgical cases.
• Participate in Breast Surgery Clinic throughout the week (specific schedule will be determined by the number and complement of students and residents on the service).
• Spend time with breast oncologists, pathologists, and radiologists
• Active participation in small round table didactic discussions on breast surgery.

REFERENCE
Recommended Resources:
The Breast E-Book: Comprehensive Management of Benign and Malignant Diseases 5th Edition, Kindle Edition by Bland et al.
FORMATIVE EVALUATION
Roughly at the mid-point of the rotation, the student will be prompted by the Undergraduate Education Coordinator, Ms. Debbie Thornhill, to pick up or print a Formative Evaluation Form and expedite completion. Once completed, it must be returned to Ms. Thornhill for review. If additional feedback is desired or required, Dr. Sugar will accommodate.

OUTCOME AND EVALUATION MEASURES
At the end of the course, the course director will submit an evaluation of the student’s performance. It will include references to knowledge, skill, and professionalism. Professionalism will be measured in terms of punctual attendance, maturity, approach to the patient, and interaction with faculty and other staff.
Policies & Procedures: http://catalog.lsuhscshreveport.edu/content.php?catoid=13&navoid=503

Offered: All

Pass/Fail