The Third Year Clerkship in Surgery Weill Cornell Medical College The Third Year Clerkship in Surgery Weill Cornell Medical College New Resident Orientation

Orientation Session Objectives Identify rationale for residents as teachers in clerkships Identify rationale for residents as teachers in clerkships Describe clerkship, including format and learning objectives Describe clerkship, including format and learning objectives Define students roles and responsibilities Define students roles and responsibilities Define residents roles and responsibilities Define residents roles and responsibilities

Rationale for Residents as Teachers Teaching is our professional responsibility Teaching is our professional responsibility –Professionalism Teaching can aid our own learning Teaching can aid our own learning –Practice-based learning Residents have most contact with students Residents have most contact with students –Increased opportunity to observe the students and to be observed by the students

The Clerkship Personnel: Director – M. Michael Eisenberg, M.D. Director – M. Michael Eisenberg, M.D. Associate Director – Sandip Kapur, M.D. Associate Director – Sandip Kapur, M.D. Clerkship Coordinator – Krista Jenkins Clerkship Coordinator – Krista Jenkins Administrator – Kristi Volpp Administrator – Kristi Volpp

The Clerkship Format: Format: 12 weeks 12 weeks –8 weeks of rotation on General Surgery services –4 weeks of elective rotations & Anesthesiology Formal didactic teaching, tutorial sessions, house staff conferences, and core curriculum days at NYPH Formal didactic teaching, tutorial sessions, house staff conferences, and core curriculum days at NYPH Evaluation by Attendings, shelf exam, tutors and you! Evaluation by Attendings, shelf exam, tutors and you! –Honors, High Pass, Pass, Fail

The Clerkship Requirements: Patient log Patient log Direct observations Direct observations Clinical evaluation Clinical evaluation

The Clerkship More Student Objectives: Act professionally at all times Act professionally at all times Participate in patient care as active team member Participate in patient care as active team member Demonstrate clinical reasoning skills Demonstrate clinical reasoning skills Demonstrate critical thinking skills Demonstrate critical thinking skills Demonstrate self-directed learning Demonstrate self-directed learning

The Clerkship Learning and Teaching Venues: In the clinical setting In the clinical setting In conferences In conferences In core lectures In core lectures In tutorial sessions In tutorial sessions

The Clerkship Where is the student? With you With you With the patient With the patient In tutor group In tutor group In lecture In lecture

The Student Learner Learner Active team member Active team member –Active participation vs. scut Liaison between patients and family and team Liaison between patients and family and team

The Student Responsibilities as Team Member: Attends all rounds and conferences with the team Attends all rounds and conferences with the team Responsible for his/her own patients Responsible for his/her own patients –Pre-rounds on own patients –Writes admission, daily, and off-service notes Responsible to get resident co-sign or write an agree with note within 24 hours Responsible to get resident co-sign or write an agree with note within 24 hours –Presents at rounds Patient data and mini-lecture Patient data and mini-lecture –Accompanies patient to consultations and procedures Assists in care of all patients Assists in care of all patients

The Resident Roles: Teacher Teacher Supervisor Supervisor Evaluator Evaluator Role model Role model

The Resident As Teacher : Set expectations for performance Set expectations for performance Promotes self-directed learning Promotes self-directed learning Teach at the bedside Teach at the bedside –Demonstrate –Observe –Provide feedback Teach through the day Teach through the day –Think out loud –Include a Teachable Moment –Deliver and assign mini-lectures

The Resident As Supervisor: Assign patients and tasks to promote students learning and to integrate them into team Assign patients and tasks to promote students learning and to integrate them into team Assure adequate supervision of students as they provide patient care, including performing procedures Assure adequate supervision of students as they provide patient care, including performing procedures Co-sign notes or write agree with notes within 24 hours Co-sign notes or write agree with notes within 24 hours Co-sign orders Co-sign orders

The Resident As Supervisor-- Physical exams and procedures: The student exam does not count, you must examine each patient yourself The student exam does not count, you must examine each patient yourself Students must be chaperoned when performing pelvic exams Students must be chaperoned when performing pelvic exams Students may perform procedures for which they have been certified with general supervision, other procedures must be performed with direct supervision Students may perform procedures for which they have been certified with general supervision, other procedures must be performed with direct supervision Students may not accompany monitored patients off the floor Students may not accompany monitored patients off the floor Students may not administer any meds, immunizations, or IVF Students may not administer any meds, immunizations, or IVF

The Resident As Supervisor--Notes and Orders: Student notes contribute valuable information Student notes contribute valuable information Student notes can impact on medical-legal matters Student notes can impact on medical-legal matters Co-sign all student orders Co-sign all student orders –Although students can write orders under your direction, these orders cannot be taken off without your co-signature

The Resident As Supervisor--Notes : You must read the student note and write your own note You must read the student note and write your own note –Your note should be able to stand alone Every student note must be co-signed or have an agree with (med student name) note signed by the supervising resident within 24 hours Every student note must be co-signed or have an agree with (med student name) note signed by the supervising resident within 24 hours If you have a difference of opinion with a clinically significant part of the student note, explain this in your note in a neutral manner; e.g.: If you have a difference of opinion with a clinically significant part of the student note, explain this in your note in a neutral manner; e.g.: –I agree with med student note, except that on my examination, murmur is not audible.

The Resident As Evaluator: Provide ongoing, timely feedback Provide ongoing, timely feedback Contribute to summative evaluation Contribute to summative evaluation –Turn in your evaluation forms ASAP!!! –Most students sometimes exceed expectations –Comments on specific, observed behaviors are essential Your comments contribute to the Deans letter Your comments contribute to the Deans letter A pleasure to work with is not useful A pleasure to work with is not useful

The Resident As Role Model: You are a walking, talking textbook You are a walking, talking textbook Hidden curriculum Hidden curriculum –That which is learned through role modeling, rather than explicit teaching, through acculturation and assimilation Learning may be subconscious Learning may be subconscious –Can be more powerful than the explicit curriculum of the classroom

THANK YOU!