Joan C. Edwards School of Medicine - Marshall University



SUR 833

COURSE TITLE, DEPT. & COURSE NO: Surgical Intensive Care Unit, Surgery, SUR 833

Course Location: CHH, MU Medical Center

COURSE DIRECTOR AND COURSE CONTACT NAME PHONE NUMBERS, E-MAIL ADDRESSES:

Course Director: Contact Name:

David A Denning, MD Lisa Clagg-Blizzard

304 691-1299 304 691-1281

denning@marshall.edu Clagg@marshall.edu

Course Objectives:

1. To gain experience with monitoring and evaluation of the critically ill surgical patient.

2. To provide a broad exposure to fundamental concepts of critical care including ventilator management, hemodynamic monitoring, fluids and electrolytes, and nutritional support.

3. To develop an understanding and basic skills in the assessment, initial resuscitation, management and recovery of post surgical intensive care patients from a wide variety of surgical disciplines including general, orthopedic, trauma, thoracic and urologic.

4. To understand the indications for common surgical intensive care procedures.

INSTITUTIONAL GOALS AND OBJECTIVES MET OR ADDRESSED

Patient Care:

At the end of this rotation, students will be able to:

1. Recognize and comprehend management of problems commonly encountered in the surgical critical care arena.

2. Demonstrate basic knowledge and skill level necessary to manage critically ill surgical patients.

3. Perform a comprehensive history and physical examinations on the critically ill.

Medical Knowledge:

At the end of this rotation, the student will demonstrate:

1. A basic working understanding of: resuscitation and endotracheal intubation; mechanical ventilation; hemodynamic monitoring using arterial, central venous pressure and pulmonary artery catheters; nutritional support including total parenteral nutrition and monitoring; interpretation of blood gas and other monitoring data; management of major postoperative problems such as bleeding and sepsis, and an understanding of organ system failure and shock.

2. An increased understanding of the pathophysiology of acute injury, surgical stress, shock, infection, and surgical complications common to patients sustaining acute injury and/or requiring surgical intensive care management.

3. An increased understanding of:

a. Resuscitation of patients from blunt and penetrating trauma.

b. Management of vascular injuries.

c. Ventilator management.

d. Continuous renal replacement therapy.

e. Sepsis and septic shock management.

f. Management of ARDS.

g. Basic aspects of patient resuscitation.

Practice Based Learning and Improvement:

The student will demonstrate ability to:

1. Complete assigned reading.

2. Identify knowledge gaps and seek out methods to correct.

3. Putting into practice self-directed learning habits by utilizing online resources for reading assignments and assessment and evaluation of medical literature related to patients’ health problems.

Interpersonal and Communication skills:

Student will demonstrate ability to:

1. Obtain history from a critically ill patient.

2. Discuss warning signs of complications associated with surgical critical care.

3. Educate patients and families about medical conditions.

4. Communicate patient information with other members of the health care team.

Professionalism:

Student will demonstrate ability to:

1. Obtain informed consent.

2. Maintain patient confidentiality.

3. Use professional judgment in caring for patients.

4. Function as a member of a surgical care team.

5. Be reliable and dependable for patient care.

System Based Practice:

Student will demonstrate

1. Ability to utilize consultants.

2. An understanding of the costs of various treatment options associated with the treatment of critically ill patients.

3. An understanding of the principles of cost containment as related to caring for critically ill patients.

4. Ability to understand one’s position within the team, specialty, profession and society.

ASSESSMENT METHODS

Mid Point Evaluation

In accordance with LCME standard ED-30, the Course Director will evaluate student performance at mid-point to review the student’s professional, clinical and academic performance up to that point. The formative evaluation must be reviewed with the student and the student will have an opportunity to discuss with the Course Director. The form must be signed by the student and returned to the Course Director. The Course Director shall then forward a copy of the form to the Office of Academic Affairs. The form will NOT however be included in the student’s official academic record. Since this is a two week selective, students will be provided with an oral feedback at the end of the first week.

On-Line Final Examination- 25%

A final on-line exam will be given at the end of the rotation. Study material and readings will be assigned at the beginning of the rotation and students are encouraged to read the material early in the course. Students must score at least 75% to pass the on-line exam. Passage of the examination is a requirement for passage of the course – irrespective of the student’s performance on other components of this course. Students may retest one (1) time only and must retake the examination within two weeks. A successful retake will result in the student’s score being the average score of the two attempts. An unsuccessful second attempt will result in failure of the course, irrespective of other academic or clinical performance.

Students who are unable to retest within the required two week period must submit a written request to the Course Director to be granted permission to delay the retake. The Course Director will decide if the request is acceptable and notify the student of whether the request is granted. The Course Director’s decision may be appealed to the Department Chair whose decision is final.

Preceptor Evaluation- 75%

Grading H – Honors P – Pass F – Fail

The preceptors’ evaluation will be based upon, but are not limited to, the following factors:

• Attendance and participation in tutorials

• Conference attendance

• Maturity and Professionalism

• Oral Case Presentation/Patient Workup

• Participation in call

• Participation in Clinic and OR Hours

• The demonstration of basic knowledge of patient care during clinic

Each Assessment Component listed above (on-line final, case presentation and preceptor evaluation) must be passed in order to successfully complete the course.

Required Reading:

Surgery: Scientific Principles and Practice by Greenfield. Chapter 9 Critical Care,

pp 217-243

Other readings as assigned

MUJCESOM Policies: All medical students taking this course will comply with School of Medicine policies given at . Individual policies can be found at the following websites:

Student Infectious Material Exposure:



MS-IV Attendance:



Academic Dishonesty Policy:



Academic Standards Policy:



Policy for Students with Disabilities:



University Computing Services’ Acceptable Use Policy:



Affirmative Action Policy:

pp. 16-17



Inclement Weather Policy:



Notification of delays and cancellations of classes are posted on the Medical Education Home Page when Marshall University Main Campus is not in session



ATTENDANCE

See MUSOM Year 4 attendance policy

DRESS CODE

1. Students must wear appropriate attire when caring for patients, attending lectures, exams, conferences and case presentations.

2. Appropriate attire includes:

• Clean shirt with ties (for males)

• Clean, white laboratory or clinic coat

• Clean, pressed trousers or skirts

• Identification name badge

• Polished shoes

• Identification name badge

3. The following items of dress are NOT ACCEPTABLE:

• Jeans

• Shorts or Capri’s

• Sandals, flip-flops, sneakers, tennis shoes, jogging shoes, Birkenstock, earth, open toe

• Low cut blouses or sweaters, midriff tops

• Skirts above the knee

4. Scrubs suits belong in the OR. They are not to be worn on the wards, except when emergency situations arise too quickly to permit changing clothes, or when returning to the OR immediately. On such occasions a clean laboratory coat must be worn over the suit. Shoe covers, hats & mask are NOT to be worn outside of the OR at any time.

5. Scrub suits or portion of scrub suits are NOT to be worn outside the hospital for any reason.

6. Hair is to be neatly cut & combed.

7. Beards and mustaches are to be neatly trimmed.

8. Students are to attend to their dress and personal hygiene at all times, including after a night on-call.

9. Smoking: Cabell Huntington, St. Mary’s and the HVAMC are smoke free facilities. Smoking is only permitted in designated areas.

EXPOSURE TO BLOOD AND BODY FLUIDS PROTOCOL

EMERGENT STEPS TO TAKE IF EXPOSED TO BLOOD/BODY FLUIDS

IMMEDIATE Protocol for Blood/Body Fluid Exposure

STEP 1: IMMEDIATE TREATMENT

Percutaneous (needlesticks/sharp objects) Injury (where there is the slightest suggestion that the integrity of skin has been broken by a potentially contaminated item)

1. Wash wound thoroughly with a sudsy soap and running water; if water is not available use alcohol. Betadine soap, not Betadine solution, is acceptable for this step. (this first step with soap directly reduces the viruses ability to infect)

2. Remove any foreign materials embedded in the wound.

3. Disinfect with Betadine solution.

Non-intact Skin Exposure

1. Wash skin thoroughly as in #1 above.

2. Disinfect with Betadine solution.

There is no evidence that squeezing the wound or applying topical antiseptics further reduces the risk of viral transmission.

Mucous Membrane Exposure

Irrigate copiously with tap water, sterile saline or sterile water.

Intact Skin Exposure

Exposure of intact skin to potentially contaminated material is not considered an exposure of any significant risk and therefore the “exposee” is neither considered an exposed person nor in need of evaluation. Thoroughly clean and wash exposed intact skin.

STEP 2: EXPOSURE PROTOCOL

1. Report the exposure to the clerkship director, residency program director, clerkship coordinator, or department chair.

2. Report to the nearest Emergency Department

3. After treatment in the Emergency Department, contact Chris McGuffin at 304-691-1178 for post exposure incident reporting.

STEP 3: MEDICAL TREATMENT FOLLOW-UP

Report the next business day or as soon as practically possible to the Walk-In Clinic at University Internal Medicine or your own primary care physician, if you so choose, for follow-up and direction.

REMEMBER TO:

• Remind others (while you seek immediate medical attention) to obtain consent and test source individual’s blood (requesting a rapid HIV antibody Test, Hep B and C) immediately or ASAP if the patient is not on premises. If the source individual is known to be infected with either HIV or HBV, testing need not be repeated to determine the known infectivity.

• Identify and document the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law.

• Ensure that your emergency room visit is not reported as a Worker’s Compensation Claim. Medical students’ health insurance will be billed; however, Marshall University Joan C. Edwards School of Medicine will cover up to $500 of unreimbursed expenses. It is the responsibility of the medical student to insure that his or her health insurance is billed. Medical students are responsible for providing the Office of Student Affairs with a copy of the bill for medical services rendered and the Explanation of Benefits from their health insurance.

Reviewed and updated: June 26, 2009

For more detail on Post Exposure Protocol visit:



BLOOD/BODY FLUID EXPOSURES ARE AN EMERGENCY!

STUDENT MISTREATMENT/SEXUAL HARARRASMENT

Marshall University School of Medicine’s policy statement on Student Mistreatment is located in the Medical Student Handbook. The Department of Surgery considers issues of student harassment (including sexual harassment) as a serious offense and the University Policy for dealing with such issues will be strictly adhered to in such matters. For more information on the Institutional Standards of Behavior (Student Mistreatment) Policy, go to

Policy Statement Regarding Student Work Hours

The following adapted ACGME work hour rules have been incorporated as the MUSOM Policy Statement Regarding Student Work Hours:

• Students must not be scheduled for more than 80 clinical duty hours a week.

• Students must have one day in seven free of patient care activities.

• Students must not be on overnight call more frequently than every third night.

• Students must not be expected to be on call for more than 24 hours, with an added period of up to 6 hours for continuity, educational debriefing and didactic activities. Students should not be expected to evaluate new patients after 24 hours.

• A minimum of 10 hours rest period should be provided between clinical duty periods.

CASE PRESENTATION FORMform to be placed on this page (as soon as JTW turns it in)

| | |

|Hospital: |Patient Medical Record Number: |

| | | | | |

|Grading Scale: 4 = Excellent 3 = Above average 2 = Average 1 = Unsatisfactory |4 |3 |2 |1 |

|Knowledge of topic | | | | |

| Chief complaint | | | | |

| Relevant anatomy | | | | |

| Treatment options | | | | |

| Indications for Surgical Intervention | | | | |

| Complications | | | | |

| Literature pertaining to case | | | | |

|Presentation skills | | | | |

| Description of the case | | | | |

| Action taken | | | | |

| Outcome | | | | |

| Status | | | | |

|Speaking Skills | | | | |

| Audible | | | | |

| Clear/Understandable speech | | | | |

| Correct terminology | | | | |

| Pace | | | | |

| Use of video/audios | | | | |

| Response to questions | | | | |

| | | | | |

|Comments: |

| |

| |

| |

| |

| |

| |

|Total Score: ________(Calculated by Dept.of Surgery) Faculty Signature:____________________ |

| |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download