THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE PREPARING FOR THE THIRD-YEAR STUDENT CLERKSHIP IN SURGERY Roger P. Tatum, MD Assistant Professor of Surgery Director of Medical Student Surgical Education November 25, 2008

Objectives 1.demonstrate a method of focused evaluation and workup of the surgical patient 2.Identify what constitutes appropriate surgical referral 3.Perform a thorough abdominal exam 4.Identify the important factors in the diagnosis, workup, and management of various specific surgical problems 5.Perform some basic surgical techniques

Structure of Clerkship Each student will be assigned to a surgical team or group of surgery attendings Each student will be assigned to a surgical team or group of surgery attendings Average day will consist of am rounds, followed by OR or clinic, conference(s), and (likely) evening rounds Average day will consist of am rounds, followed by OR or clinic, conference(s), and (likely) evening rounds

Requirements of the Clerkship Clinical Grade: a combination of your performance on the wards with the residents and attendings, as well as the patient write-ups and literature review Being present in clinic, on the wards, and in the OR is essential Being present in clinic, on the wards, and in the OR is essential Enthusiasm goes a long way! Enthusiasm goes a long way!

Requirements of the Clerkship Final Exam: Given the last day of the rotation Given the last day of the rotation Multiple-choice standardized exam Multiple-choice standardized exam Questions will be related to topics in the learning objectives (on the website) Questions will be related to topics in the learning objectives (on the website) Very important component of the final grade! Very important component of the final grade!

Clerkship Sites—Seattle University of Washington Medical Center (UWMC) University of Washington Medical Center (UWMC) Harborview Medical Center (HMC) Harborview Medical Center (HMC) VA Medical Center—Seattle (VAMC) VA Medical Center—Seattle (VAMC) Virginia Mason Medical Center (VMMC) Virginia Mason Medical Center (VMMC)

Clerkship Sites—WWAMI Region VA Medical Center—Boise, ID (VAMC—Boise) VA Medical Center—Boise, ID (VAMC—Boise) Sacred Heart Medical Center, Spokane, WA Sacred Heart Medical Center, Spokane, WA Fairbanks Memorial Hospital, Fairbanks, AK Fairbanks Memorial Hospital, Fairbanks, AK Missoula, MT Missoula, MT Billings, MT Billings, MT Casper, Wyoming Casper, Wyoming Madigan Army Medical Center, Fort Lewis, WA Madigan Army Medical Center, Fort Lewis, WA

Clerkship Sites Each site is different in terms of the variety of patients and cases seen Each site is different in terms of the variety of patients and cases seen Lectures are available on-line for WWAMI sites Lectures are available on-line for WWAMI sites Seattle sites may be best (especially UWMC, HMC, and VAMC) for students interested in Surgery as a career Seattle sites may be best (especially UWMC, HMC, and VAMC) for students interested in Surgery as a career

5-6 students 5-6 students Tertiary referral center—typically more complex or advanced cases, as well as some more common surgical problems Tertiary referral center—typically more complex or advanced cases, as well as some more common surgical problems UWMC

5-6 students 5-6 students Trauma center—high volume of blunt and penetrating trauma cases (call can be very busy), some routine and advanced general surgery, less surgical oncology Trauma center—high volume of blunt and penetrating trauma cases (call can be very busy), some routine and advanced general surgery, less surgical oncology Harborview

3-4 students 3-4 students Tertiary referral center for VA system Tertiary referral center for VA system Wide variety of general surgery cases, many surgical oncology cases, less emergency cases Wide variety of general surgery cases, many surgical oncology cases, less emergency cases No trauma No trauma Predominantly male population Predominantly male population VAMC—Seattle

2 students 2 students Wide variety of general surgery cases, many more complex cases Wide variety of general surgery cases, many more complex cases No trauma No trauma VMMC

1-2 students 1-2 students More of a community general surgery experience, less of the complex cases More of a community general surgery experience, less of the complex cases Students are more independent—no residents at these sites Students are more independent—no residents at these sites Boise, Spokane, and Fairbanks

1 student 1 student community general surgery experience community general surgery experience Students will be independent— no residents Students will be independent— no residents Apprentice-style learning Apprentice-style learning Abundant outdoor recreation (skiing, hiking, et al.) Abundant outdoor recreation (skiing, hiking, et al.) Missoula, Montana

1 student 1 student community general surgery experience with 2 groups of six surgeons each; includes trauma community general surgery experience with 2 groups of six surgeons each; includes trauma Family Practice residency on- site Family Practice residency on- site Mid-sized community with numerous resources Mid-sized community with numerous resources Abundant recreation Abundant recreation Billings, Montana

1 student 1 student community general surgery experience with high- volume surgeons; includes trauma community general surgery experience with high- volume surgeons; includes trauma Family Practice residency on-site Family Practice residency on-site Casper, Wyoming

1-2 students 1-2 students Broad range of general surgery and sub-specialties Broad range of general surgery and sub-specialties Surgery residency training site—student will be on a surgical service Surgery residency training site—student will be on a surgical service Madigan Army Medical Center

SURGERY CLERKSHIP Clerkship Sites Check the Surgery Clerkship website ( rst.html) at least 3 weeks prior to starting the clerkship for information specific for your site—you will need to submit information to the site coordinator Check the Surgery Clerkship website ( rst.html) at least 3 weeks prior to starting the clerkship for information specific for your site—you will need to submit information to the site coordinatorhttp://depts.washington.edu/surgstus/CLERKSHIP/fi rst.htmlhttp://depts.washington.edu/surgstus/CLERKSHIP/fi rst.html