CLINIC AND OR SCHEDULES ROYAL UNIVERSITY HOSPITAL CTUA Monday Tuesday Wednesday Thursday Friday AM Keith OR Academic ½ day* Christian OR Shaw/Luo/ Moser/Beck OR Christian clinic 8:00-noon* Ogaick clinic 9:00 – 12:00 PM Keith OR Shaw/Luo/ Moser/Beck OR: alternating every other Monday Shaw clinic 1-4pm Shaw/Luo/ Moser/ Beck clinic: 1-4:00, alternate every week Christian OR Keith clinic 2-4:30 Christian clinic 1-4:00* Ogaick clinic 1:00 – 4:00 Keith Clinic Resident's Academic ½ day (JURSI's can attend) Bolded* sections indicate priority activities for the JURSI assigned to that CTU CTUB Monday Tuesday Wednesday Thursday Friday AM Academic ½ day* Stevenson OR Kanthan OR Stevenson clinic 8:00 –11:30 PM Kanthan clinic 12:30-4:00* Stevenson OR Kanthan clinic* 12:30-4:00 Kanthan OR Resident's Academic ½ day (JURSI's can attend) *Bolded* sections indicate priority activities for the JURSI assigned to that CTU
Nutritional and fluid needs and options for replacement. Potential complications: prevention strategies. Patient support systems and options for post hospital care. POST-OPERATIVE COMPLICATIONS – OBJECTIVES: Describe the differential diagnosis of a patient having postoperative fever. For each entity, discuss the clinical manifestations, appropriate diagnostic work-up, and management: Intraoperative - malignant hyperthermia Within 24 hours - response to surgical trauma; atelectasis; necrotizing wound infections. Between 24 and 72 hours: pulmonary disorders (atelectasis, pneumonia) catheter related complications (IV-phlebitis, Foley-UTI) After 72 hours: infectious (UTI, pneumonia, wound infection, deep abscess, anastomotic leak, prosthetic infection, acalculous cholecystitis, parotitis) noninfectious (deep vein thrombosis) Discuss the following wound complications in terms of predisposing risk factors (patient condition, type of operation, technique), as well as their recognition, treatment, and prevention: hematoma and seroma wound infection dehiscence incisional hernia Discuss the various causes of respiratory distress and respiratory insufficiency that may occur in the postoperative patient. For each complication, describe the etiology, clinical presentation, management, and methods of prevention: atelectasis pneumonia aspiration pulmonary edema ARDS pulmonary embolism (including deep venous thrombosis) fat embolism Discuss the diagnostic work-up and treatment of oliguria in the postoperative period. Include pre-renal, renal, and post-renal causes (including urinary retention). Discuss the possible causes of hypotension which may occur in the postoperative period. For each etiology describe its pathophysiology and treatment: hypovolemia sepsis cardiogenic shock - including postoperative myocardial infarction, fluid overload, arrhythmias, pericardial tamponade medication effects
radiography, angiography, IVP Special diagnostic/interventional techniques: upper endoscopy, procto- sigmoidoscopy, colonoscopy, laparoscopy. Discuss the presentation, diagnostic strategy, and initial treatment of patients presenting with common or catastrophic abdominal conditions. acute appendicitis cholecystitis/biliary colic/ choledocholithiasis/ cholangitis pancreatitis peptic ulcer disease with and without perforation gastroesophageal reflux gastritis/duodenitis diverticulitis inflammatory bowel disease enterocolitis small bowel obstruction: incarcerated hernia, adhesions, tumor colon obstruction: volvulus, tumor, stricture splenomegaly/splenic rupture mesenteric ischemia leaking abdominal aortic aneurysm gynecologic etiologies: ectopic pregnancy, ovarian cysts (torsion, hemorrhage, rupture) tubo-ovarian abscess, salpingitis, endometriosis genito-urinary etiologies: UTI, pyelonephritis, ureterolithiasis, testicular torsion Discuss the common non-surgical conditions that can present with abdominal pain Examples: MI, pneumonia, pleuritis, hepatitis, gastroenteritis, mesenteric adenitis, sickle cell crisis, DKA, herpes zoster, nerve root compression. Compare and contrast acute appendicitis in young adults, the very young, very old, and pregnant women. Discuss issues relevant to presentation, diagnosis, treatment, complications etc. Example: perforation risk. Discuss the diagnosis and treatment of abdominal problems with particular relevance to the pediatric population. Include: neonates, infants, children, adolescents. Be able to list the abdominal problems, characteristic of each group, and outline diagnostic and intervention strategies for: Congenital: hernias, malrotation, midgut volvulus Hirschsprung’s disease Pyloric Stenosis Intussuception Meckel’s diverticulitis Child abuse
ED2 REQUIREMENTS Log: Surgery Log 2015-16 Competency list: Phase D Surgery Logging Requirements Evaluate (focused history and targeted physical exam) of a review patient with a surgically oriented problem in the inpatient/outpatient setting Evaluate (focused history and targeted 1 0 physical exam) of a review patient with a oriented problem in the inpatient/outpatient setting Evaluate and manage postoperative pain in the inpatient setting Evaluate and manage postoperative pain in 1 0 the inpatient setting Evaluate patients for infectious postoperative complications in the inpatient/outpatient setting Evaluate patients for infectious 1 0 postoperative complications in the inpatient/outpatient setting Write daily progress note in the health record documenting an inpatient's hospital course Write daily progress note in the health 1 0 record documenting an inpatient's hospital course Write a brief operative report in the health record Write a brief operative report in the health 1 0 record Scrub, gown and glove for operations Scrub, gown and glove for operations 1 0
JURSI Oral Examination Surgery ** This is now going to be 25% of your final grade. Student: Date: Examiners: Time: The objective of the oral examination is to evaluate the student’s clinical reasoning/problem solving skills. This will be done by presenting a patient oriented problem in one of the following areas: 1. acute abdomen 2. appendicitis 3. biliary tract disease 4. breast problems 5. pulmonary embolism/DVT 6. GI hemorrhage 7. bowel obstruction 8. gastroesophageal reflux 9. shock 10.. fluid & electrolyte management 11.. principles of wound management 12.. head & neck examination They are to be evaluated on the following objectives: 1. obtain the relevant history 2. request pertinent information about the physical examination 3. discuss the differential diagnosis and justify the most likely diagnosis 4. request the appropriate investigations (lab, imaging, etc.) 5. discuss the management of the problem Please document questions asked and quality of answers on the back of the sheet, then grade using the following criteria: EVALUATE THE STUDENT’S PERFORMANCE IN THIS ORAL EXAM -evaluate based on your expectations of performance for a student at this level, not the level expected of a physician Check one grade* EXCELLENT – above average 95 [ 85 [ ] ] SATISFACTORY – pass 75 [ ] 65 [ ] 55 [ ] FAIL 45 [ ] Filled out by Dr. [ ]
GENERAL COMMENTS Phase D Evaluation Descriptors Core Clinical Skills Interviewing skills and history taking Appropriately apply use of open-ended and closed ended questions Physical examination Records and reports Technical capabilities, perform procedures suitable to this level Problem Solving - Clinical Reasoning Information gathering - has an acceptable approach to patient management problems Diagnosis - can support investigations (rationale) Define and prioritize problem list Understands relative importance of signs and symptoms in support of differential diagnosis Knowledge Base Fund of knowledge - including self education and current literature Able to explain and justify approaches to patient management problems with reference to pathophysiology, pharmacology and various treatment options Professional - personal conduct Reliable, prompt, punctual and dependable Shows curiosity and initiative Participation is appropriate, volunteers Communication and interpersonal skills Establishes rapport and relates well to patient Demonstrates respect for patient, families, colleagues and other health professionals Speaks and writes clearly Organizational skills and confidence Works harmoniously with colleagues and other professionals
FINAL JURSI GRADE SHEET Oral Examination: 25% N.B.M.E.: 25% Clinical Evaluations by Preceptors: 40% Problem-based Surgery Seminar (Rubric): 10% To be completed by On this form, you will be evaluating For dates: to Final JURSI grade sheet Fails to meet Expectations Meets Expectations Exceeds Expectations Core clinical skills Problem solving − clinical reasoning Knowledge base PROFESSIONALISM Fails to meet Expectations Meets Expectations Exceeds Expectations Attendance/ Punctuality Communication/ interpersonal skills Reliability Appropriate behavior and attitudes Confidentiality Comments: