Student Rotations

The General Surgery Residency Program at New Hanover Regional Medical Center welcomes third and fourth year medical students from UNC-Chapel Hill, and when space is available, fourth year medical students from other institutions. It is our goal to provide four (4) and/or eight (8) weeks of advanced training and education in the setting of a large community hospital and trauma center. The following rotation information relates to third and fourth year medical students:

Educational goals:

• To enable a meaningful clinical experience with inpatient and outpatient surgical problems from the community/county hospital perspective.
• To provide an opportunity to see and understand human anatomy through direct operating room experiences.
• To foster an understanding of the risks and benefits associated with surgical therapy when applied to both acute and chronic health problems.
• To develop skills in pre-operative and post-operative care as well as basic surgical skills required for emergency room and outpatient surgical procedures.
• To teach problem solving and decision making skills through rounds and clinical presentations derived from current patient encounters.
• To hone communication skills prerequisite for optimal professional interactions.

Students will acquire knowledge related to:

• Trauma-resuscitation, evaluation and diagnosis, care of specific conditions, surgical critical care including use of invasive lines, ventilator management, nutrition, sedation.
• Pre-operative risk assessment and post-operative complications.
• Acute abdomen including presentations related to peptic ulcer disease, biliary disease, large and small bowel obstruction, diverticular disease, appendicitis, hernia and miscellaneous surgical problems.
• Learn to efficiently evaluate surgical patients.
• Write focused H&P's and progress notes.
• Learn effective oral patient presentation skills.
• Develop operating room experience including scrub technique, participation at the OR table, correlation of pathological findings with signs and symptoms of disease and understanding of operative decision making.
• Understand the importance of multidisciplinary care.
• Develop technical skills including venipuncture, placement and removal of NG tubes, Foley catheters, dressing wounds, managing drains and basic suturing.

Learning Activities:

Students will participate in all aspects of patient care including admissions, developing an assessment and management plan and communicating with patients and their families. Students will be assigned to the Surgical ICU, following patients and managing care. Daily rounds, weekly conferences, departmental rounds and taking call are all required activities. Students will be exposed to a wide variety of general and specialty surgical procedures. Students will have:

• A minimum of 15 eight-hour clinical shifts.
• A minimum of six (6) hours of weekly didactic conferences, including simulation labs and hands-on instruction.
• Direct observation/participation experience with a full history and physical exam.
• Direct observation/participation experience in the OR.
• Interest and curiosity are admired even though surgery may not be your chosen field. Though we do not depend on medical students for their service contribution at this hospital, there are times when "everyone carries a shovel."

In-house and Sub-specialty rotations:

Each third year student ranks their choices for sub-specialty surgical rotations prior to coming to Wilmington. For third year students, your two months will be spent with one month (4 weeks) on house staff and the other four (4) weeks will be split into two, two week blocks in which you will be doing your sub-specialty surgical rotations. We make every effort to schedule the students with their top two choices, and definitely two of their top four choices. The first of your sub-specialty rotations are scheduled by this office the week prior to your start at NHRMC and not finalized until that time. You will be notified of your rotation schedule during orientation on your first day here. Future sub-specialty rotations are scheduled the week prior to their start date. Fourth year students will be assigned to two weeks on house staff and two weeks on one of the community practices to optimize your exposure to a diverse surgical population and operative experience.

Evaluations:

Evaluations are completed on each student by the preceptors and faculty after review with the residents and staff, as well as by full time and community teaching surgeons. Mid-rotation evaluations will be provided as well as are daily opportunities to discuss personal progress and perspectives with faculty during lecture/group sessions. Final evaluations from this rotation are taken from a composite of all input. The value of this rotation will be proportional to the energy the student chooses to invest in it. At the end of your rotation students will meet formally meet with the student preceptor(s) and/or Program Director, so that we can be responsive to your input and improve the student educational experience.

You will be evaluated on the following, based on the Six Core Competencies: Medical Knowledge, Patient Care, Professionalism, Practice-Based Learning and Improvement, System-Based Practice and Interpersonal and Communication Skills, including but not limited to: decision making; case presentation; history taking and physical exam skills; communication with patients, families, nurses, consultants, PCP's, residents and faculty; organization; test interpretation; self-directed learning; surgical knowledge, self-improvement and objective achievements.

Operating Room:

Day 1 of the rotation includes a demonstration of hand washing and scrubbing. This is required regardless of previous OR experience. One huge advantage of the NHRMC experience is the broad access one has to the spectrum of general surgery performed every day. Students will scrub in on surgical cases scheduled to the service on which they are rotating with (either surgical house staff or the community attendings). Participation will often extend beyond observation as you may be asked to assist surgeons, residents or staff during performance of operations. Preparation enables smooth entry. Always read up on cases before you enter the operating room to optimize your experience and contribution to the case.

Patient Care:

Students who are on House Staff will be assigned to follow patients in the STICU. All bedside procedures will be monitored and supervised by the Chief, Senior Resident or Attending surgeon. Opportunities to participate in floor rounds, consultations, and trauma resuscitations will arise while on call. Students rotating on private services will participate in floor rounds, office practice, and OR schedules.

Call:

Call assignments are delegated by Chief Resident or Senior Residents on House Staff. One will round with the House Staff team while on call in the early evening and the following morning as assigned. Students are expected to take one week-day call as well as two weekends (alternating with week-day call). All students will take some form of in-house call.

Pager:

Students are assigned pagers at the beginning of their rotation for use during the rotation. They are to be returned to the Program Administrator at the end of the rotation. It is expected that the pager will be kept on while in the hospital. Problems due to pager malfunction should be reported promptly to the Program Administrator.

Scheduled clinics, rounds & conferences: You will be given a sheet which details the month's conference and clinic schedule. Although many of the conferences can be attended while on non-housestaff rotations, precedence is given to the demands of the community surgeon or specialist rotation with the exception of mandatory conferences. You will be advised of the mandatory conference schedule upon arrival for the rotation.

IMPORTANT! Any procedure that you perform in the clinic or the emergency room must be supervised! This means in the presence of a resident or attending surgeon.

Holidays:

Official holidays recognized by the medical school are also holidays during the clerkship and are outlined in your orientation folder.

Rotation Time Off:

There may be occasion where students become ill, need to travel back to the university for meetings with the staff or for testing. The Program Administrator and/or Chief Resident on Service should be notified as soon as possible of any requested time out of the hospital. Students taking more than two days off during the rotation will be required to make up this time.

Suggested reading: Standard text books of surgery and surgical operative atlases serve as valuable paper references. The Lange series Current Surgical Diagnosis and Treatment is an abbreviated text with relevant and well-presented information in both general and specialty areas. The ACS weekly literature series and SCORE Curriculum represent other particularly valuable resources and are incorporated into the Department's weekly education venue. Numerous resources including on-line access are available in the Fales Library which is adjacent to the Surgical Pavilion and open on a 24 hour basis. For third year medical students: as your sub-specialty rotations may not be scheduled with a lot of advance notice, your orientation packet will contain general information for your top four sub-specialty choices. More specific and direct reading may be done once your rotations are scheduled and you are able to view what cases are scheduled in the OR.

The surgical rotation may represent the first step in your career as a surgeon. Our goal however is to assist students as they continue to add to their general knowledge and experience base prerequisite for success in their chosen field. General surgery represents an immensely satisfying field. That there is already a general surgeon shortage in the United States only underscores the need to keep it that way.

For more information about the program or how to sign up for a rotation, please contact Kathy Radley, Program Administrator at [email protected] or Beth Smith, Surgery/Student Administrative Associate at [email protected].