Primary Course Syllabus

University of Kansas School of Medicine

Surgery 900 Junior Surgery Clerkship

Primary Course Syllabus

Description of Course and Materials, Objectives and Competencies, and Grading

Description of Course and Materials

Surgical problems and diseases are studied utilizing didactics, skills laboratory experiences, study questions, clinical problem discussion, assigned readings, live patients and simulations. This course prepares the 3rd year student to meet the pertinent aspects of the Summative Competencies of the University of Kansas School of Medicine typically during the third year of medical school. A particularly important goal of this course is to teach the student to identify life-threatening conditions that require urgent intervention. Although the skills of this course are necessary for an ambulatory practice, the skills that are taught in this course are most frequently seen and performed in the hospital setting. The student is expected to have successfully completed Phase I of Medical School and possess the ability to demonstrate competent understanding of normal and abnormal body structure and function, ability to competently perform and document a History and Physical Examination, and ability to competently record diagnoses and procedures experienced.

Texts distributed at orientation:

Lawrence, Peter F., Essentials of General Surgery, Williams and Wilkins, Baltimore, MD
Lawrence, Peter F., Essentials of Surgical Subspecialties, Williams and Wilkins, Baltimore, MD
Jarrell, Bruce E. and Carabasi, III, Anthony R., NMS National Medical Series for Independent Study
Didactic Handouts

Other Resources:

Video Tapes of Skills Demonstrations may be checked out from the Surgery Education Office.
Surgery Education website http://classes.kumc.edu/som/surg900/ especially the Didactic Schedule with links to the Association for Surgical Education (ASE) and lecturer’s support materials.

Surgery Core Curriculum Learning Objectives

In accordance with the Association for Surgical Education (ASE) and its Manual of Surgical Objectives, 4th Edition, the following topic areas define the core curriculum of this course.

At completion of the course the student will be able to evaluate, assess and manage patients with:

1.	Abdominal Mass	12.	GI Bleeding
	a. Abdominal Mass		a. Upper GI Bleed - Duodenal Ulcer
	b. Adrenal Mass		b. Lower GI Bleed
			c. Ulcerative Colitis
2.	Abdominal Pain
	a. Appendicitis	13.	Jaundice
	b. Diverticulitis
	c. Acute Cholecystitis	14.	Leg Pain
	d. Intussusception
	e. Mesenteric Ischemia
	f. Acute Pancreatitis	15.	Lung Nodule
	g. Incarcerated Incisional Hernia
	h. Right Lower Quadrant Pain / Crohn's Disease
		16.	Neck Mass
3.	Altered GI Function
	a. Constipation
	b. Vomiting Newborn - Malrotation	17.	Perioperative Care

4.	Altered Neurologic Status	18.	Postoperative Care

5.	Asymptomatic Patient / Positive Test	19.	Scrotal Pain / Swelling
			a. Inguinal Hernia
6.	Anorectal Disease
	a. Anorectal Pain - Abscess	20.	Shock

7.	Back Pain	21.	Skin / Soft Tissue Lesions
			a. Skin Lesion - Melanoma
8.	Breast Conditions
	a. Abnormal Mammogram	22.	Swallowing Problems / Dysphagia
	b. Breast Mass
	i. Benign - Fibroadenoma	23.	Transplantation
	ii. Malignant - Breast Cancer

9.	Chest Pain - Shortness of Air	24.	Trauma
	a. Chest Pain Gastroesophagel Reflux Disorder (GERD) b. Shortness of Air - Pulmonary Embolus		a. Burns b. Penetrating Chest Trauma - Cardiac Tamponade c. Tension Pneumothorax
10.	ENT Problems
		25.	Urinary Complaints
11.	Fluid / Electrolyte Problems
		26.	Various
			a. Ethical Considerations
			b. Bariatrics

Surgery 900 Competency-Based Curriculum Document

The objectives and the competencies of this document can be linked to the Clinical Performance Rating (CPR) forms used by this course.

PATIENT CARE
Objectives	Competency (defined)	Instructional Method	Assessment Method/Pass Criterion	Course Benchmark
Students will acquire History and Physical Exam skills which lead to accurate assessment and planning of Surgical Care.	The competent student performs an H & P which is thorough, follows standard format, and develops an appropriate assessment and plan.	Clinical teaching in inpatient and outpatient settings by attendings and residents; assigned readings.	Clinical Evaluation by Faculty and Residents. At least a “Satisfactory” evaluation of performance.	Perform and log at least one H & P with sign off on the Procedure/Skills signature card; Clinical Performance Rating (CPR).
MEDICAL KNOWLEDGE
Objectives	Competency (defined)	Instructional Method	Assessment Method/Pass Criterion	Course Benchmark
Students will acquire knowledge of common disease processes in which standard treatment includes surgical considerations (see core curriculum above and diagnosis targets). Students will demonstrate competent skill in basic surgical techniques and know the proper application of those skills. Skills are listed in the "targets" document and skills signature form.	The competent student has adequate knowledge of surgery. The competent student has adequate skills in surgery.	Clinical teaching in outpatient and inpatient settings by attendings and residents; didactic sessions, small group and lab sessions; assigned readings. Clinical teaching by attendings, residents, nurses.	NBME “Shelf” Exam / Score 56 or above (~10^th%ile nationally). Assessment by skill instructor at or above “Satisfactory” level.	All students take the “Shelf” exam on the final day of the Clerkship; Clinical Performance Rating (CPR). Completion of skills card and “target” procedure list by end of Clerkship, with proper authenticating signature; Clinical Performance Rating (CPR).
PRACTICE BASED LEARNING AND IMPROVEMENT
Objectives	Competency (defined)	Instructional Method	Assessment Method/Pass Criterion	Course Benchmark
Students will develop knowledge, skills, attitudes and behaviors toward learning, which perpetuate lifelong learning, inquisitiveness and evidenced based practice.	The competent student continually learns and improves.	Immersion with mentoring, and demonstration by attendings, residents and ancillary health care providers.	Observation and direct interaction. At or above “Satisfactory” level.	Clinical Performance Rating (CPR); OSCP (treatment options and literature review sections, especially).
INTERPERSONAL AND COMMUNICATION SKILLS
Objectives	Competency (defined)	Instructional Method	Assessment Method/Pass Criterion	Course Benchmark
Student will communicate and collaborate with peers, mentors and allied health care personnel in an effective and professional manner.	The competent student communicates and interacts effectively in oral, written and electronic forms, and uses appropriate language, tone and mannerisms.	Immersion and mentoring in clinical inpatient and outpatient settings, conferences and discussions.	Observation of communication and interpersonal interaction. At or above “Satisfactory” level.	Presentation of OSCP; daily clinical performance during rounds, OR, and clinic experiences as rated on the Clinical Performance Rating (CPR).
SYSTEM-BASED PRACTICE
Objectives	Competency (defined)	Instructional Method	Assessment Method/Pass Criterion	Course Benchmark
Students will understand the roles of medical students on the Surgery Clerkship and the role of Surgeons in health care delivery.	The competent student performs and participates adequately in clinical care appropriate to his/her ability and the clinical environment.	Immersion and mentoring with attendings, residents, nurses and ancillary health care professionals; Orientation didactics and materials (readings).	Observation and direct interaction. At or above “Satisfactory” level.	Clinical Performance Rating (CPR); OSCP (treatment options and literature review sections, especially).
PROFESSIONALISM
Objectives	Competency (defined)	Instructional Method	Assessment Method/Pass Criterion	Course Benchmark
Students will demonstrate professional appearance, attendance and behavior consistent with that expected of a physician-in-training.	The competent student behaves professionally in all venues and contexts including clinical and non-clinical environments.	Immersion with and demonstrated behavior by attendings, residents and staff; didactics in Orientation.	Observation and interaction. At or above “Satisfactory” level.	Clinical Performance Rating (CPR); Attendance at required course components.

Grading
Your grade is determined by your performance in the following areas:
Areas Evaluated:	Percent of Final Course Grade
Cognitive Skills Final Exam (NBME Surgery Subject Exam)	35%

Oral Student Case Presentation (given near the end of the 8 week Clerkship)	15%

Clinical Performance Rating (Competency Evaluation) Patient Care Student is learning the skills necessary to provide care that is compassionate, appropriate and effective. Medical Knowledge Student is learning to apply their knowledge to biomedical, clinical, and social sciences effectively to patient care. Practice Based Learning and Improvement Student is learning to use evidence and methods to investigate, evaluate, and improve patient care. Interpersonal and Communication Skills Student is learning to effective communication skills and maintains professional and therapeutic relationships. Systems-Based Practice Student is learning to understand and demonstrate knowledge of optimal health care delivery. Professionalism: Student demonstrates behaviors that reflect ongoing commitment to continuous professional development, ethical practice, and sensitivity to diversity. Overall Clinical Performance Rating Comments	50%
Other evaluations which contribute to the assessment of professionalism in Surgery 900 include areas which are not graded on a percentage scale. These include Completion of the Skills Card, Completion of the Mid-Clerkship Evaluation with Attending, and Maintaining a Timely Recording of Patient Encounters.
Student Expectations:	Expectation
Satisfactory Attendance: Absence from Orientation, Mid-Clerkship Feedback Session, Oral Student Case Presentation, or Final Exam will result in “Incomplete” {at a minimum} and will require remediation and repeat of session or Clerkship at a future offering. You are expected to attend conferences, Surgical Grand Rounds, Didactics and Labs and to read the required textbooks and handouts.	Required
Professional Attire: Dressing in appropriate street clothes for work each day and remembering scrubs are appropriate attire for the OR and for times spent on-call.	Required
Mid-Clerkship Evaluation: In preparation for the Feedback Session, students must meet face-to-face with the attending to complete the “Mid-Clerkship Student Progress Report” and the “KU School of Medicine Mid-Rotation Feedback Form”. Non-compliance will require remediation.	Required
Maintaining a Timely Recording of Patient Encounters:	Required
Completion of Skills Signature Card: It is the student’s responsibility to obtain the confirmation signatures as they experience the required skills/procedures.	Required
Diagnosis/Problem Targets and Skills Targets: Students are required to meet assigned targets. Each student should strive to achieve a total experience of approximately 200 entries over the course of the 8 week block.	Required

The following is a link to the Skills Signature Form: Skills Signature Form

The following is a link to the Skills Targets Form: SkillsTargets

The following is a link to the Diagnosis Targets Form: Diagnosis Targets

Final Exam:

The NBME Surgery Subject Exam (Shelf Exam) is the final exam for this course and is given on the final day of the 8-week course. This scale identifies the key breakpoints in the conversion of NBME grade to the KUMC Scaled % used for final course grade calculation.

NBME Grade	KUMC Scaled %
≥ 77	≥ 90%
70 - 76	81.66 - 88.80%
63 - 69	73.33 - 80.47%
56 - 62	65.00 - 72.14%
≤ 55	≤ 64.99%

A minimum score of 56 must be achieved on the NBME Surgery Subject Exam (Shelf Exam) to successfully pass the course. Students who do not score at least 56 on this exam will be graded “Incomplete” until the Exam is retaken and an NBME grade of 56 or more is achieved. It is highly recommended that the student who fails the NBME Surgery Subject Exam view the following link: Surgery 900 Recommendations For Self Assessment for Shelf Failure

Students who fail the Subject Exam will be required to retake the Subject Exam at the date indicated on the "Repeat Postponement of Shelf Exam Schedule". If the student passes the exam on the second attempt and has a passing course grade they will receive a "Satisfactory" for the course.

Students who fail the exam on the second attempt, or who do not take the exam within the required time period, will receive an Unsatisfactory and will be required to repeat the Surgery Clerkship. When a student is required to repeat the Surgery Clerkship for low academic performance reasons (such as failure of the Subject Exam on the second attempt or an overall Unsatisfactory Course Grade) the highest grade achievable will be “Satisfactory”. Grade determination for other reasons for repeating the Surgery Clerkship (illness, other hardship) will be considered on a case-by-case basis.

Final Course Grade:

The Final Course Grade is determined by adding the component scores from the 3 main areas (Cognitive Skills, Oral Student Case Presentation and Competency Evaluation) using the percent of Final Course Grade formula above.

* Final Course Grade for Surgery 900 is determined by the following scale:

Superior	90.00 - 100%
High Satisfactory	82.00 - 89.99%
Satisfactory	65.00 - 81.99%
Unsatisfactory	64.99% and below

Policy for Challenging Borderline Grades:

If the student’s Final Course Grade is one that is borderline (i.e. slightly below the threshold for the next higher grade) and the student seeks consideration for the next higher grade, the following policy applies:

To be considered a borderline grade, the student’s calculated Final Course Grade at the time grades must be submitted to the Registrar’s Office must be within 2.00 percentage points of the next higher grade threshold. KU SOM policy requires that grades be finalized and submitted from Clerkships within 6 weeks of the end of the block.
To be eligible for consideration of the next higher grade, the student must have achieved, on first attempt, an NBME Surgery Subject Exam (Shelf) score which is in the range to which the student wishes to have his/her final grade elevated. (i.e. if the student’s grade is borderline to superior and the student wishes his/her grade to be elevated to superior, the student must have achieved a “Shelf” score in the superior range using the KU % conversion scale).
If conditions 1 and 2 are met, the student may request (in writing to the Surgery Education Office), an opportunity to undergo an Oral Examination by selected Surgery Faculty. The Surgery Education Office will arrange the time, date, and Faculty who give the oral examination. The Faculty who give the Oral Examination will make the recommendation to the Surgery Clerkship Director as to whether the student’s grade should be moved to the next higher grade level. That decision will be final. If a grade change occurs, the Surgery Education Office will notify the Registrar’s Office.
The Surgery Education Committee determined this policy, July 2005.

DISCLAIMER: All course material will be covered as time and circumstance permit.

Learning assistance, academic performance enhancement, and psychological services at KUMC are free, confidential, and available at Student Counseling & Educational Support Services by calling 913-588-6580 or visiting G116 Student Center.

Any student in this course who needs an accommodation because of a disability in order to complete the course requirements should contact the instructor or the Equal Opportunity/Disability Specialist (913-588-7813, TDD 913-588-7963) as soon as possible

Updated 07/08