University of Kansas School of Medicine

Surgery 900 Surgery Clerkship

Medical Student Procedure Skills

 

 

 

 

 

 

Target identification and tracking log

Use this form at Feedback Session and End of Clerkship

 

 

 

 

 

 

Student’s Name:

 

Date of Block:

 

 

 

 

 

 

 

 

# 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)

Sterile Technique

5

 

 

OR Orientation

 

Immobilize Neck/Extremity

1

 

 

 Didactic

 

Apply Wound Dressing

5

 

 

Video

 

Suture Repair Wound/Laceration

5

 

 

Didactic/Lab

 

Remove Wound Closure

5

 

 

Video

 

Nutritional Support

1

 

 

Didactic/Lab

 

Endoscopy

2

 

 

Didactic/Lab

 

Ostomy Care

1

 

 

Video

 

Intravenous Line Insertion

1

 

 

Didactic/Lab

 

Draw Arterial Blood

1

 

 

Video

 

ABG Analysis

1

 

 

N/A

 

Draw Venous Blood

1

 

 

Didactic/Lab

 

Present Focused H & P

1

 

 

N/A

 

Present/Diagram Surgical Anatomy

1

 

 

N/A

 

Record SOAP Note

10

 

 

N/A

 

Insert Nasogastric Tube

1

 

 

Video

 

Insert Foley Catheter

1

 

 

Video

 

Insert Endotracheal Tube

1

 

 

Video

 

Digital Rectal Exam/Test Stool for Blood

1

 

 

N/A

 

Informed Consent

1

 

 

Didactic/Lab

 

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