General Objectives for the Surgical Clerkship

ATTITUDES

1. Recognize, understand, and BELIEVE that internists and surgeons are both trying to help the patient even though approaches may differ.

    

2. Appreciate the psychological consequences of a surgical procedure.

    

3. Take time to communicate with the patient on a personal, non-medical basis.

    

SKILLS

1. Demonstrate correct technique to prep and drape a sterile field.

    

2. Perform simple suturing and/or stapling of the skin.

    

3. Perform a history and physical examination, with specific attention to the breast exam, the abdominal exam, and the vascular exam.

    

4. Write daily progress notes and orders, preoperative notes and orders, postoperative notes and orders.

    

5. Draw venous blood, insert intravenous cannula, and draw arterial blood.

    

6. Insert a naso-gastric catheter and a urethral (Foley) catheter.

    

KNOWLEDGE

Detailed, specific learning objectives are described an accompanying booklet.

While it would be ideal for all students to read and thoroughly understand one of the major surgical textbooks, this is impossible during a short clerkship. Therefore, you should develop knowledge of basic surgical disease and when to refer a patient to a surgeon.

Major principles to be mastered during the surgical clerkship include but are not limited to:

1. Examination of the patient "from the surgeon’s point of view," with special attention to
   

   1. the breast exam

   2. the abdominal exam

   3. the pulse (vascular) exam

       

2. Evaluation and care of the pre-operative and post-operative patient, including appropriate orders,

    

3. Sterile technique,

    

4. Fluid resuscitation and therapy,

    

5. Basic wound evaluation and care,

    

6. Hemostasis, blood component therapy, and anticoagulation, including DVT prophylaxis and treatment

    

7. Nutritional support (both enteral and parenteral),

    

8. Malignant neoplasia and its effects on the body systems,

    

9. Infections and appropriate prophylactic and therapeutic antibiotic use,

    

10. Basic principles of minimally invasive surgery,

     

11. The diagnosis and treatment of:

     

1. Shock: hypovolemic, septic, neurogenic, and cardiogenic,

    

2. Trauma: penetrating, blunt, thermal (frostbite and burn), and chemical,

    

3. The acute abdomen,

    

4. Hernias,

    

5. Gastrointestinal hemorrhage: upper and lower,

    

6. Peptic ulcer disease,

    

7. Biliary tract disease: stones and obstruction,

    

8. Pancreatitis: acute and chronic,

    

9. Portal hypertension and variceal hemorrhage,

    

10. Appendicitis,

     

11. Colonic and ano-rectal diseases,

     

12. Arterial occlusive disease,

     

13. Venous disease and thromboembolic phenomena, including DVT prophylaxis,

     

14. Endocrine gland diseases: thyroid, parathyroid, adrenal, pancreas, testicle, ovary,

     

15. Breast masses and disease,

     

16. Cancer (basic principles of neoplasia, diagnosis and screening, chemotherapy, radiation therapy, surgical therapy, and molecular biological interventions), especially breast, colon, gastric, pancreatic, lung, and skin.

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