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University of Kansas School of Medicine Surgery 900 Surgery Clerkship Medical Student
Procedure Skills |
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Target identification and tracking
log |
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Use this form at Feedback Session
and End of Clerkship |
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Student’s Name: |
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Date of Block: |
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# of Target Encounters Required at Minimum |
# of Acutal Encounters At Feedback Session |
# of Actual Encounters At Clerkship Completion |
Alternative Added Activities Which Count |
Target Met? (this column for clerical use only) |
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Sterile Technique |
5 |
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OR Orientation |
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Immobilize
Neck/Extremity |
1 |
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Didactic |
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Apply Wound Dressing |
5 |
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Video |
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Suture Repair
Wound/Laceration |
5 |
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Didactic/Lab |
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Remove Wound Closure |
5 |
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Video |
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Nutritional Support |
1 |
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Didactic/Lab |
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Endoscopy |
2 |
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Didactic/Lab |
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Ostomy Care |
1 |
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Video |
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Intravenous Line
Insertion |
1 |
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Didactic/Lab |
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Draw Arterial Blood |
1 |
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Video |
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1 |
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N/A |
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Draw Venous Blood |
1 |
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Didactic/Lab |
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Present Focused H
& P |
1 ● |
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N/A |
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Present/Diagram
Surgical Anatomy |
1● |
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N/A |
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Record SOAP Note |
10● |
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N/A |
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Insert Nasogastric Tube |
1 |
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Video |
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Insert Foley
Catheter |
1 |
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Video |
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Insert Endotracheal Tube |
1 |
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Video |
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Digital Rectal
Exam/Test Stool for Blood |
1● |
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N/A |
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Informed Consent |
1 |
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Didactic/Lab |
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In order to count as
an encounter participation as an observer, assistant, doer, teacher, or via
an alternative activity is acceptable in all cases except where noted with ●. In those cases the student must do/perform
the skill |
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