The Third Year Clerkship in Surgery

Orientation time: 7:30AM

Welcome to the third year clerkship, consisting of five weeks on the General Surgery service, at Columbia University College of Physicians and Surgeons. Ms. Doris Leddy is the Clerkship Coordinator. Her office is MH7-307 G.S. extension 5-9596, and her e-mail address is dl642@columbia.edu.

Dr. Roman Nowygrod is the Surgery Clerkship Director. His email is: rn5@columbia.edu

They are available by appointment or on the fly.

Enclosed in your syllabus is a daily schedule of your activities and obligations.

There are didactic sessions with the faculty addressing Curriculum topics. The Curriculum topics are derived from the required textbook: Essentials of General Surgery by Peter F. Lawrence, 4th edition. You should prepare yourself by reading the appropriate chapter from your textbook in advance of the talks.

Required Reading — Your main source for your reading should be:

• Essentials of General Surgery by Peter F. Lawrence, Fourth Edition. This book will be loaned to the medical students, during their surgery clerkship rotation.

Highly Recommended:

• How to Be a Truly Excellent Junior Medical Student by Robert J. Lederman, MD
• National Medical Series (NMS) Surgery Casebook by Bruce E. Jarrell, 1st edition
• Blueprints Q&A Step 2 Surgery, 2nd Edition

Additional recommended resources include:

• Kaplan Medical USMLE Step 2 CK QBook (Surgery Section), 2011
• Cope's Early Diagnosis of the Acute Abdomen by William Silen 20th Edition.
• The Mont Reid Surgical Handbook by David R. Fischer & Burnett S. Kelly, Jr. 5th Edition.
• Surgical Recall by Lorne H. Blackbourne, Sixth Edition
• Surgical Attending Rounds by Cornelius M. Dyke & Eric J. DeMaria, Third Edition
• Landmark Books listing under Surgery (http://library.cumc.columbia.edu/content/3rdyear): includes the four classic middle-to-advanced level texts (Schwartz, Sabiston, Greenfield, ACS

In addition, departmental lectures (Pathology) occur on Mondays. The Department of Surgery Grand Rounds and Case Conference sessions are held Thursday mornings in the Daniels Auditorium, in the Vivian & Seymour Milstein Family Heart Center. Your attendance is required. Consult your service chiefs regarding topics that will be covered.

Attendance at all departmental lectures and didactic sessions is mandatory and these talks take priority over other activities. The only acceptable excuse for missing a lecture is that you were scrubbed in on a case with your patient.

You will meet with your Preceptor at least 2 hours/weekly. Topics relevant to General Surgery but not addressed in the didactic sessions or departmental lectures will be covered. Preceptors will also elaborate upon and answer questions stemming from the Curriculum based talks. You will have the opportunity to present cases to your Preceptor.

Preceptor sessions will be scheduled directly by your Preceptor at your mutual convenience. Late afternoon meetings with your Preceptor are encouraged as they do not conflict as much with time spent in the operating room and doctors' offices.

An orientation to the operating room will be held in the OR on the orientation day. It will be conducted by Sandra Hyman, operating room nurse. Attendance is mandatory.

Scrub suits or "blues" are available for your use during the rotation and are mandatory in the operating room. They are not to be taken home and are not to be worn outside the OR unless covered by a white coat.

Surgical Procedures

At the medical student surgery orientation, the students are given a list of surgical procedures that are mandatory for them to scrub on during the rotation. Some of these cases are not performed at the Allen, so it is necessary that those students in the Allen come down to Milstein to participate in these cases.

On-Call Experience and Work Hours

Students should use the on-call experience to gain familiarity with the de novo workup of a surgical patient (from history and physical through higher level diagnostics), operative management of acute general surgical problems, and algorithmic approach to patient care in the postoperative setting. For example, the students should help work up and write admission notes on any new patients coming in, write post-op notes on patients who come out of the recovery room late in the day, and assist with the team-based response to patient emergencies. In this way, students are exposed to many conditions other than the ones commonly treated by their team. The best way to meet these objectives is to work side-by-side with the on-call surgery consult resident who sees all new consults and emergencies (at Milstein, pager #88882). If there are no pending consults, seek out the intern covering the general surgery floor for exposure to management of acute postoperative problems (at Milstein, pager #85936).

Students at all sites should expect to take in-house call approximately every fourth night, or at least one call per week on service. At any given time at CUMC, there should be at least one or two students on call at Milstein Hospital. For students at all sites, at least TWO calls should be 24-hour calls on Friday or Saturday nights. This minimizes disruptions to your didactic and elective case schedule, while exposing you to the unique case mix and continuity of care that are associated with the overnight experience. On weeknights, you should be dismissed to go home at the very latest by 11PM if there are no patients in the operating room or waiting to be seen, so that you can return the next morning to see your patients, round with your team, and attend elective cases and didactics. If you are busy in the operating room overnight, consider your next day's schedule and consult with your chief resident to plan when you should leave and return to the hospital.

Medical students must adhere to the same work hours rules governing residents. You should work no more than 80 hours per week, averaged over 4 weeks. In addition, you must have a minimum of 8 hours off between shifts. You will be asked to record and turn in your work hours weekly via email to Doris Leddy at DL642@columbia.edu.

Lockers:

Two medical students will be assigned one lockers on MH 7 Hudson North, room 109. Doris Leddy will assign those lockers for each rotation.

Beepers:

One student from each service will sign-out a beeper from the clerkship coordinator at the beginning of the rotation. This student will be personally responsible for returning the beeper at the rotation's end: No Beeper = No Grade. Be sure the beepers are functioning well with good battery charges. Fresh batteries are available from the clerkship coordinator. If your beeper should malfunction, report it immediately to the clerkship coordinator for replacement.

There is an $75.00 fee for lost beepers. Students should always be reachable through the team beepers, so if you are in the O.R., or otherwise unable to return pages, please pass the beeper along to another team member who can respond.