FOR MEDICAL SCHOOL USE ONLY



THORACIC SURGERY

SUR 810

Course Title, Department, & Number: SUR 810, Thoracic Surgery

Course credit or length: 2- 4 Weeks

Course directors and contact information (office phone and e-mail):

Dr. Rebecca Wolfer; wolferr@marshall.edu; 304.691.1299

Course coordinator and contact information (office phone and e-mail):

Lisa Clagg-Blizzard, 304.691.1281; Clagg@marshall.edu

Course location: Cabell Huntington Hospital

Course Description: During this course, students will play an active role in the management of thoracic surgical patients. As part of a close knit team, the students will be supervised by residents and attending staff in diagnosis and pre- and post-operative care of patients undergoing general thoracic surgery. 

Institutional Objective

Patient Care - Students must demonstrate the ability to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Course Objectives

The students will be able to demonstrate an understanding of appropriate preoperative, operative, and postoperative evaluation and management of common thoracic patients. The demonstration shall include an understanding of the etiology, diagnosis, clinical presentation, and surgical treatment of the common diseases.

Outcome Measures

The students will be able to demonstrate orally to a faculty member the ability to perform an appropriate preoperative, operative, and postoperative evaluation and management of at least three of the five thoracic patients listed below. The students shall also demonstrate orally to a faculty member basic understanding of the etiology, diagnosis, clinical presentation, surgical treatment (including preoperative, operative, and postoperative evaluation and management) of at least three of the following thoracic surgical problems to be randomly selected by the faculty member:

• Empyema

• Lung cancer

• Spont pneumothorax

• Thoracic trauma

• Vent management

The students’ knowledge shall also be demonstrated by the on-line examination.

Institutional Objective

Medical Knowledge- Students must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.

Course Objective

The students will be able to:

1) Discuss workup of a patient with a solitary pulmonary including differential diagnosis and diagnostic evaluation.

2)    Discuss different types of malignant pulmonary lesions and the treatment options.

3)    Discuss interpretation of CXR for cardiopulmonary pathology.

4) Discuss the etiology and treatment options for pneumothorax.

5) Discuss the types of pleural effusions, the etiologies, differential diagnosis and management options.

6) Discuss the types of mediastinal masses, the etiologies, differential diagnosis and management options.

Outcome Measure

The students will be able to:

1) Discuss with a faculty member the workup of a patient with a solitary pulmonary including differential diagnosis and diagnostic evaluation.

2)    Discuss with a faculty member different types of malignant pulmonary lesions and the treatment options.

3)    Discuss interpretation of CXR for cardiopulmonary pathology with a faculty member.

4) Discuss with a faculty member the etiology and treatment options for pneumothorax.

5) Discuss with a faculty member the types of pleural effusions, the etiologies, differential diagnosis and management options.

6) Discuss with a faculty members the types of mediastinal masses, the etiologies, differential diagnosis and management options.

The students’ knowledge will also be demonstrated by the on-line examination.

Course Objective

The students will be able to identify normal anatomy associated with thoracic surgery.

Outcome Measure

The students will orally identify and describe to the faculty the anatomy associated with the following:

• Empyemas,

• Lung cancer

• Malignant pulmonary

• Mediastinal masses

• Pneumothoraxes

• Solitary pulmonary

• Thoracic trauma

The students’ knowledge will also be demonstrated during the on-line examination.

Institutional Objective

Professionalism- Students must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Course Objective

Students must behave in an ethical, responsible, reliable and dependable manner.

Outcome Measure

Students will be directly observed by faculty to determine ethical behavior, reliability and level of dependability.

Basic Science Objectives

At the end of this course, the student will be able to identify the following to the faculty:

• Causes of shock and delineate how to differentiate types

• Mechanism of action of the different pressor agents commonly used in ICU

• The most common cell types in lung cancer

• Different types of pleural effusions.

• The most common etiologies

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.

For a two week elective, students will be provided with an oral feedback at the end of the first week.

On-Line Final Examination- 50%

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 70% 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. The exam will be 25 questions and must be scheduled at least one week in advance by the student contacting Kelly Webster Fuller at 304.691.1743. Students may retest one (1) time only and must retake the examination within two weeks. 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.

Case Presentation- 25%

The student will be required to give a 10-15 minute case presentation at a pre-arranged time during their clinical rotation. The presentation will be given to the course director and medical students. Students will be notified of the date and time of their presentation one week in advance. The course director will assess the presentation and assign a percentage score. See Case Presentation Form under General Information for grading details.

Preceptor Evaluation- 25%

Grading A= 90-100% B= 80-89% C= 70-79% F= below 70%

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.

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

If at any time the medical student is unable to meet their clinical responsibilities they must notify their Clinical Faculty Preceptor and the Department of Surgery at 691-1280 during working hours Monday-Friday, 8:30 am - 5:00 pm. All absenteeism will be required to be made up with two days required for every day missed.

If a student misses 2 or more unexcused days, the student will be required to reschedule the entire rotation. Request for an excused absence must be submitted in writing at least one week in advance via the Student Scheduler to the course coordinator. The request will be reviewed by the course director who will either grant or deny the request. Excused absences will not be retroactively granted.

Attendance at Surgical Grand Rounds, Journal Club and Surgical Morbidity and Mortality Conference is mandatory with the exception of being assigned to the operating room by your preceptor. Unexcused absences will result in one extra case presentation for each absence.

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.

Required Reading: Essentials of Surgical Specialities, 3rd Edition, Peter Lawrence, MD

CASE PRESENTATION FORM

ew form 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 Department of Surgery) |

Faculty Signature: ____________________________________________

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