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Surgery Obj

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  COURSE OBJECTIVES SPECIFIC SURGERY PRACTICUM OBJECTIVES/STUDY TOPICS  1.   Perform and document an admission history and physical examination, with identification and discussion of normal and abnormal findings. 2.   Describe indication and techniques used in providing universal precautions and infection control procedures or patients and health care workers including sterile surgical technique. 3.   Develop and document assessment and plan in the inpatient &/or outpatient record. 4.   State the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications commonly used in surgical practice. 5.   For patients presenting with the conditions listed below (Common Surgical Entities): A. Perform a problem-oriented history and physical examination, B. List related differential diagnosis. C. Determine a tentative diagnosis. D. Direct a primary care diagnostic evaluation and E. Order, a primary care-level clinical treatment plan, which includes:    Pharmacologic and non-pharmacologic interventions    Patient education    Further diagnostic studies    Appropriate referrals or consultation; and follow-up F. Common Surgical Entity Topics    Acute surgical abdomen    Intracranial tumor/aneurysm/AVM    Goiter/neck mass    Carotid ASHD    Lung tumor    Pulmonary embolism    Pneumothorax/hemothorax    Breast mass/cancer    Mallory- Weiss syndrome    Esophageal varices    Peptic ulcer disease    Gastritis    Gastric carcinoma    Cholecystitis/lithiasis/cholangitis    Pancreatitis    Bowel obstruction (small and large)    Meckel’s diverticulum      Diverticulitis    Appendicitis    Mesenteric adenitis    Crohn’s disease      Thrombophlebitis    Volvulus    Intussusception    Colon cancer    Hemorrhoids    Anal fissure    Perirectal abscess    Portal hypertension    Hernia (hiatal/abdominal/inguinal)    Arteriosclerotic occlusive disease    Renal calculi    Prostatic hypertrophy     Hypovolemic shock    Septic shock    Aortic aneurysm    Injured/burned patient General Surgery (4 weeks) By the end of the general surgery practicum, the student should possess a thorough understanding of the following concepts as they relate to the care of the surgical patient: 1.   Pre, peri and post operative evaluations and care 2.   Fluids and electrolytes 3.   Nutrition 4.   Surgical bleeding and blood replacement 5.   Shock 6.   Wounds and wound healing 7.   Surgical infections 8.   Trauma 9.   Burns Additionally, the student shall be expected to achieve a fundamental understanding and knowledge of the diagnosis and management of surgical disease states involving the following anatomic regions, systems or conditions: 1.   Abdominal wall including hernia 2.   Esophagus 3.   Stomach and duodenum 4.   Small intestine and appendix 5.   Colon, rectum and anus 6.   Biliary tract 7.   Pancreas 8.   Liver 9.   Breast 10.   Surgical endocrinology 11.   Spleen 12.   Surgical oncology The student should be able to recognize (through appropriate use of historical and physical examination skills), and know the differential diagnosis and management of the following post-operative complications: 1. Fever 2. Wound infection 3. Pulmonary embolism 4. Pneumonia 5. Urinary retention 6. Ileus 7. Constipation 8. Renal failure 9. Wound dehiscence/evisceration 10. Adhesions 5 11. Atelectasis 12. Arrhythmias 13. Deep venous thrombosis 14. Hematoma 15. Urinary infection While the general surgery rotation shall have as its focus surgery as a discipline, the student is expected to acquire an appreciation for surgery as a craft. Patient care opportunities in the ambulatory clinic, hospital wards and operating room should be used by the student to develop the following skills: 1.   Sterile technique to include scrubbing, gowning, gloving and care of the operative field. 2.   Use of surgical instruments. 3.   Wound care including simple suture techniques, debridement and dressings. 4.   Application and care of surgical drains and tubes.   At the completion of the rotation in general surgery, the student should be able to apply his/her knowledge of the foregoing concepts to the management of patients with medical problems frequently encountered by the general surgeon. Such clinical presentations may include those discussed during the course of the rotation or any of the following: 1.   Breast complaints 2.   Abdominal pain or mass 3.   Jaundice 4.   Intestinal obstruction 5.   Upper or lower gastrointestinal bleeding 6.   Soft tissue infection Formulate clinical conclusions regarding the interpretation of the following tests or procedures and discuss advantages and disadvantages of these tests or procedures as well as the use of each. Abdominal plain film Abdominal Ultrasound Barium enema, with & without air contrast Chest X-ray CT scans Electrocardiogram Intravenous Pyelography Mammogram MRI Oral cholecystogram Plain-film radiographs(spine, extremities, chest, abdomen) Nuclear scans  SPECIFIC SPECIALTY SURGICAL PRACTICUM OBJECTIVES/STUDY TOPICS   Orthopedics (4 weeks)  At the end of the orthopedic section of the clerkship, the student should: 1.   Demonstrate the ability to perform and discuss the orthopedic history and physical examination. 2.   Be able to interpret x-rays of the musculoskeletal systems. 3.   Outline the treatment rationale of the more frequently encountered orthopedic problems. 4.   Demonstrate knowledge and understanding of conditions presenting to the orthopedist, prioritize patient care, develop a differential diagnosis, and recommend appropriate therapeutic interventions. 5.   Accurately identify all true orthopedic emergencies that could result in the loss of life, limb, and/or cause permanent disability. 6.   Be able to recognize the patient presenting with a fracture and/or dislocation, prioritize the care for this patient, develop a differential diagnosis, and initiate appropriate and immediate therapeutic interventions. 7.   Be able to recognize the patient presenting with cervical spine trauma, prioritize the care for this patient, perform a differential diagnosis, and initiate appropriate and immediate therapeutic interventions. 8.   Fun ction as assistant in orthopedic surgery commensurate with one’s level of education.   Cardio-Thoracic and Vascular Surgery (4 weeks)  At the end of the cardio-thoracic/vascular section of the practicum, the student should: 1.   Demonstrate familiarity with the various diagnostic and physiologic tests used for evaluating patients with vascular diseases. 2.   Demonstrate knowledge and understanding of conditions presenting to the cardio-thoracic/vascular surgeon, prioritize patient care, perform a differential diagnosis, and recommend appropriate therapeutic interventions. 3.   Participate in the management of a variety of patients with arterial and venous diseases. Be able to recognize the patient presenting with an ischemic extremity, prioritize the care for this patient, perform a differential diagnosis, and initiate appropriate therapeutic interventions. Be able to recognize the patient presenting with pneumothorax, prioritize the care for this patient, develop a differential diagnosis, and initiate appropriate and immediate therapeutic interventions. 4.   Demonstrate a working knowledge of cardiac and thoracic disease processes and their management. Be able to recognize the patient presenting with severe cardiac disease, prioritize the care for this patient, develop a differential diagnosis, and be able to initiate appropriate and immediate therapeutic interventions. 5.   Demonstrate knowledge and understanding of conditions requiring cardiac transplantation, including ability to prioritize transplant candidates. 6.   Participate in the management of a variety of patients with diseases of the cardio-vascular and thoracic systems. 7.   Demonstrate understanding of the pre and post-operative care requirements for patients undergoing general cardio-thoracic surgery as well as the special requirements for patients undergoing transplantation. Otorhinolaryngology (ENT) (4 weeks)  Emphasis during the ENT section of the practicum will be on outpatient care. At the end of this section, the student should: 1.   Demonstrate skills in history taking and interviewing by working up patients with problems related to the head and neck. 2.   Demonstrate knowledge and understanding of conditions presenting to the otorhinolaryngologist, prioritize patient care, develop a differential diagnosis, and recommend appropriate therapeutic interventions. 3.   Discuss fundamentals of otoscopy, rhinoscopy, indirect laryngoscopy, and head and neck examination. 4.   Demonstrate increased clinical judgement in evaluating surgical problems. 5.   Discuss the problems of communicative disorders and hearing loss. 6.   Observe and assist in surgical procedures related to facial plastic surgery and otorhinolaryngology. 7.   Develop expertise in suturing and management of wounds. 8.   Be able to recognize the need for identification of anatomic location of bleeding site in epistaxis, plan appropriate immediate care, and make recommendations for long-term care. 9.   Be able to recognize the patient presenting with airway obstruction, prioritize the care for this patient, and initiate appropriate and immediate therapeutic interventions. Urology (4 weeks)  At the end of the urology section of the practicum, the student should: 1.   Observe and participate in the preoperative evaluation, surgical management, and postoperative care of urologic patients.
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