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Medical Education

Fourth Year Clerkship

Objectives

Master the initial evaluation of an acutely ill patient
  • Understand the pathophysiology and clinical manifestations of shock, specific operative stresses, and injuries (including brain injury, spinal cord injury and pulmonary injury).
  • Learn the philosophy, priorities, and techniques of initial resuscitation and evaluation of patients with injury, operative stress, and shock.
  • Demonstrate your knowledge in patient care by recognizing, treating, and preventing complications of injury and shock.
Gain experience in a surgical environment performing invasive diagnostic and therapeutic procedures
  • Practice all infection control and universal precaution procedures.
Develop higher level function in the management of the peri-operative and intensive care unit patients
  • Participate in ICU and General Floor care.
  • Understand the pathophysiology and clinical manifestations of pulmonary, renal, nutritional, and multisystem organ failure.
  • Implement plans of treatment of patients in shock, acute trauma patients and post-operative patients in the ICU and acute care floors.
  • Perform emergency and daily physical examination on critically ill patients and prepare progress notes in ICU and acute care floors, under supervision.
  • Understand the basic principles and commonly used modes of mechanical ventilation and be able to prescribe ventilator settings.
  • Understand the principles, indications, limitations, and physiology of invasive monitoring techniques (e.g. arterial & central venous catheters, pulmonary artery catheters, intracranial pressure monitors) and be able to interpret the information obtained.
  • Understand the principles of surgical nutrition, monitoring, assessment of needs, and be able to write a prescription for total parenteral nutrition and supplemental enteral feedings.
  • Understand the pathophysiology and management of head injury.
  • Respect patient confidentiality.
  • Work with ancillary personnel (nurses, lab techs, x-ray techs, etc.) in a collaborative fashion.
Grading

The students have daily dialogs with the faculty. They receive frequent formative feedback during the rotation. They receive summative feedback from the faculty. Clinical experience logs are reviewed. The mechanism for determination of students’ final grades is identical at all sites. The surgery department clerkship committee determines each student’s final grade. This committee reviews the student’s performance on all components of the clerkship. The final grade reflects the student’s overall and cumulative clinical evaluations, clinical examination performance, and performance on an oral presentation. The final grade is determined by weighting the clinical grade assigned by faculty (60%), the final examination (20%) and the oral case presentation (20%).

The scale for final course grades is in accordance with the Academic Rules and Regulations 23rd edition UMDNJ - RWJMS and consists of five levels: Honors, High Pass, Pass, Conditional Pass, and Fail. A grade of Fail or Conditional Pass for one component may result in a course grade of Conditional Pass. After the student remediates a final course grade of Conditional Pass, the highest remediated course grade that can be awarded is a Pass. Receiving multiple Conditional Pass evaluations or one or more Fail evaluations may result in a final grade of Fail. This grade will become part of the student’s official records. Remediation of a final course grade of Fail is possible in accordance with the Academic Rules and Regulations 23rd edition RWJMS. However, once the student remediates a final grade of Fail, the student will receive a grade no higher than Pass for the course. Extenuating circumstances can always occur and are taken into consideration by the faculty grading committee when appropriate. However, these must be made apparent immediately to the clerkship director, co-director, or the director of surgical education and are not being considered after the fact.

Clinical Sites

Currently, the Advanced Clerkship in Surgery is offered a Robert Wood Johnson University Hospital and Jersey Shore Medical Center. At Jersey Shore Medical Center, students work directly with the trauma-critical care faculty on a combined service for the entire block.