Third Year Medical Student Surgery Clerkship
Clerkship Director: Amir Berjis, MD
Professor Emeritus: Jack Bloch, MD
Clerkship Coordinator: Chris Connors
Contact: Amir Berjis, MD
Welcome to your Surgery Clerkship! This 12-week rotation will expose you to the various aspects of general surgery and its numerous subspecialties. As faculty and residents, we see this as an opportunity to teach some basic concepts about surgery that will benefit you regardless of which field you choose to enter.
This rotation will provide you with the basic didactic and practical experience in the evaluation, diagnosis and treatment of patients with disorders that may require treatment by a surgeon. The aims of surgical education in the third year are as follows:
First, the student is to acquire a body of knowledge, skills, and attitude necessary for the recognition and management of patients with diseases that may necessitate evaluation by a surgeon.
Second, the student is to become familiar with the principles, clinical reasoning, techniques and tools used by surgeons.
Finally, the student will observe and adopt the attitudes and attributes that promote good patient relations and management.
There are four basic parts to any surgery service: rounds, the operating rooms, clinic, and call. All students are expected to participate in morning rounds and will be expected to follow a minimum number of patients.
It is best to follow patients whose surgery you participated in or patients you saw in clinic who were admitted. Every general surgery and trauma case will require at least one student present to assist. It is essential to be prepared for your case, and thus students on the team should divide up cases as early as possible. Read about the patients; specifically know their presenting complaints, diagnoses, indications for surgery, and procedures being performed. Also, review the appropriate anatomy for the case.
Unless scrubbed in a case, all students are expected to be present and participate in the various surgical clinics. The clinic is a great opportunity to meet patients preoperatively. It also provides a chance to follow patients through the entire process from preoperative evaluation through to the postoperative visit. This will be an essential component of your rotation through the subspecialty clinics, since general surgery residents may not be present. Finally, all students will participate in a call schedule. Call will provide an opportunity to see urgent and emergent cases that are vital to a surgical practice.
The clerkship is divided into three rotations. Each student will rotate through 4 weeks of general surgery, 4 weeks of trauma surgery and critical care, and 4 weeks of subspecialty services and call coverage. During these rotations, students are expected to participate in the preoperative, operative and postoperative care of the surgical patient.
This four-week rotation will expose students to the fundamentals of general surgery. These broadly include evaluation of abdominal pain, gastrointestinal surgery, cancer surgery, thoracic surgery and hernia repair. Students will be divided between the two Kern Medical general surgery services: Red and Gold, as run by their respective fifth-year chief residents. At the completion of this phase, students are expected to be able to recognize common surgical problems and construct appropriate diagnostic management. They should also be able to assess suitability for surgery of patients referred with common surgical problems. Finally, they should recognize the most common surgical emergencies that require urgent surgical consultation.
Trauma Surgery and Critical Care
This four-week rotation will expose students to patients who present with trauma, including their surgical and critical care. Students will be expected to participate actively in the resuscitation and care of a patient in shock, whether in the emergency room, operating room, or intensive care unit. The medical student will also be exposed to the continuous critical care that trauma patients require and are expected to learn the basic fundamentals of such care. At the conclusion of this rotation, students are expected to understand the basic principles of advanced trauma life support and surgical critical care.
Subspecialty Service and Call Coverage
This four-week rotation will allow students to become acquainted with the various surgical subspecialties, including urology, plastic surgery, neurosurgery, otolaryngology, and orthopedic surgery. Students are assigned to rotate through all subspecialty clinics during three weeks of the rotation, while the remaining week is reserved for nightly call coverage.
During this rotation, students are expected to participate in surgical cases for patients they see in the clinics as long as the particular attending approves. In addition, students will be exposed to all surgical disciplines while participating in a week of night shift call. At the completion of this phase, students are expected to understand the basic disease processes and their respective treatments in the broad category of surgical subspecialty care.
Didactics, Lectures, and Conferences
The surgical curriculum will be taught through a combination of didactic and clinical teaching. Weekly learning opportunities include Mortality and Morbidity (M&M) Conferences, Surgery Grand Rounds, Medical Student and Resident Teaching Conferences, and Multidisciplinary Surgical Conferences. In addition, students will have a mandatory Clerkship Core Lecture Series (Didactics tab) held each week.
However, the greatest opportunities for learning surgery will take place in the operating room, the clinic and at the bedside. Students are encouraged to consider these conferences and activities a priority and should be present unless scrubbed in a case.
Third-year medical students rotating through surgery at Kern Medical will be divided into three, 4-week rotations. This outline provides a review of the General Surgery rotation.
Third-year medical students rotating in surgery at Kern Medical are expected to become familiar with the basic principles of general surgery. During this four-week rotation students are expected to participate and see patients in inpatient and outpatient settings.
General surgery at Kern Medical is divided into two services: Gold and Red Surgery, each run by its respective fifth-year chief resident. The surgical team may also include junior surgical residents, rotating residents, interns, and fourth-year medical student subinterns. As a third-year medical student, you are a vital part of this team.
During this rotation, students will be exposed to a vast array of pathology that constitutes a general surgery practice. This will include evaluation of patients who will require elective surgery in the outpatient setting and patients who will require urgent or emergent surgery in the inpatient setting. Since surgery is a consultative specialty, a patient is referred to a surgeon once a symptom or pathology is identified by the primary care physician or in some circumstances, by the emergency room physician.
It is imperative that students become familiar with and have a basic understanding of the common disease processes that require surgery. These include the evaluation of abdominal pain, one of the most common presenting symptoms. Students should actively participate in the histories and physical exams of such patients.
This rotation will also expose students to gastrointestinal surgery, cancer surgery, thoracic surgery and hernia repair. A basic understanding of these broad topics through continued reading of appropriate texts and participation in didactic lectures is required.
Exposure to patients in General Surgery will occur in two distinct situations.
In the outpatient setting, students will be expected to actively participate in seeing patients in General Surgery clinics. Such clinics are held on Mondays and Thursdays, 1-5 p.m. Unless scrubbed into a procedure, students are required to be in clinic. Students are encouraged to review the patients’ presenting complaints and symptoms, their pertinent physical exams, laboratory and diagnostic exams (including radiographic films), and the recommendations for treatment. If surgery is offered, students should read about the procedure and be prepared to assist!
Medical students will also encounter pathology from patients seen during hospital consultations. Such consultations can come from either the emergency room or other specialty services such as internal medicine, family practice, pediatrics and OB-GYN. Students are expected to assist the consulting intern/resident in the management of these patients.
At the conclusion of this rotation, students will be evaluated on their performance and enthusiasm on the General Surgery Service. Written evaluations by the fifth-year chief resident will also be provided.
Third-year medical students rotating through surgery at Kern Medical will be divided into three 4-week rotations. This outline provides a general review of trauma surgery and critical care.
Students will be exposed to and participate in the care of trauma and critically ill patients. Students will be assigned to a four-week continuous core rotation through the Trauma Surgery Service, in which they are expected to assist the interns, residents, and physician assistants in the daily care of trauma patients.
Student duties on the rotation include assistance with admission, review of radiologic films, observation of and/or assistance with bedside procedures, and active participation in the resuscitation of an acute trauma patient, including assistance in operative procedures. All trauma operative cases require the presence and assistance of medical students.
Students on the rotation are also expected to attend Trauma Clinic on Tuesdays, 1-5 p.m., if not scrubbed in the operating room.
Students are expected to gain a basic understanding of the principle of trauma management by reading appropriate texts throughout their four-week rotation. In addition, each student should review basic ATLS protocol and be familiar with appropriate trauma resuscitation guidelines. Finally, students should study the basic concepts of surgical care and how it applies to their trauma patient.
At the conclusion of this rotation, students will be evaluated on their performance and enthusiasm on the Trauma Surgery Service. Written evaluations by the Trauma/SICU Director, Dr. Ruby Skinner, and/or Dr. Andrea Pakula, will be provided.
Third-year medical students rotating through surgery at Kern Medical will be divided into three 4-week rotations. This outline provides a general overview of the Subspecialty Services and Call Coverage, a four-week rotation that is further split into one-week assignments.
Third-year medical students rotating in surgery at Kern Medical are expected to become familiar with and participate in subspecialty care. During three weeks of this rotation students are expected to participate in and see patients in subspecialty clinics and to be available for and potentially assist in subspecialty operative cases.
The following subspecialties are available at Kern Medical: neurosurgery, otolaryngology, orthopedic surgery, plastic surgery, and urology. Students are expected to be present at the clinics at the stated times wearing appropriate attire (OR scrubs and casual attire are not allowed).
The following guidelines should be followed by the rotating medical students:
- Arrive on time. Do not be late!
- Upon arrival to the clinic, please introduce yourself to the clinic staff and attending(s).
- Obtain a clinic patient schedule to determine which patients are suitable for your encounter.
- Each attending will have different guidelines as to how to approach their patients in clinic. Please ask whether:
- You can see a patient on your own and present the patient to the attending, or
- You are to shadow the attending during the patient visit
- If a patient is scheduled for surgery, ask the attending whether you can be present to observe and/or assist.
- Please be mindful of surgical residents and fourth-year medical student subinterns who take precedence in seeing patients and participating in cases.
- Read appropriate texts before you present to the clinic so you have a basic understanding of the subspecialty.
- Ask questions and make the most of your experience!
The subspecialty faculty and clinics are as follows*:
Dr. Joseph Chen
Wednesday 8 AM – 4 PM
Dr. Tung Trang, Dr. Richard Busch
Monday 8 AM – 12 PM
Tuesday 8 AM – 12 PM
Friday 8 AM – 12 PM
Friday 1 PM – 5 PM
Dr. Michael Freeman, Dr. Sara Yegiyants
Tuesday 8 AM -12 pm, 1 PM – 5 PM
Dr. Auturo Gomez, Dr. Michael Eagan, Dr. Tom Chao
Monday 8 AM – 12 PM
Tuesday 8 AM – 12 PM, 1 PM – 5 PM
Wednesday 8 AM – 12 PM, 1 PM – 5 PM
Thursday 8 AM – 12 PM, 1 PM – 4 PM
Friday 8 AM – 12 PM
Dr. Jeffery Nalesnik, Dr. Shahab Hillyer, Dr. Vinh Trang
Monday 9 AM – 12 PM, 1 PM – 5 PM
Wednesday 9 AM – 12 PM
Thursday 9 AM – 12 PM, 1 PM – 4 PM
Friday 9 AM – 12 PM
* Clinic times are subject to change. Please review the most current roster with surgery clinics.
Each medical student is expected to rotate through each clinic at least once during the three-week rotation. It is imperative that you read beforehand so that you can have a basic understanding of the subspecialty. This would include a general review of the common diseases seen in the clinics and proposed surgeries if required. Each student will be assigned to one week of urology, one week of combined plastic surgery and ENT, and one week combined of orthopedics and neurosurgery. During each assigned week, students are expected to participate in their respective clinics and operative cases.
Students are encouraged to review the patients’ presenting complaints and symptoms, their pertinent physical exams, laboratory and diagnostic exams (including radiographic films), and the recommendations for treatment. If surgery is offered during the students’ week on the rotation, students should read prior to the operative procedure and be prepared to assist! Students who are assigned to a Subspecialty Service are expected to participate in subspecialty operative cases throughout the week.
Each Thursday morning of the three-week rotation, students are expected to produce a complete history and physical on a patient that they have seen during that week of Subspecialty Service. This H/P is due at the Clerkship Director’s office by 10 a.m. each Thursday of the three-week rotation. In addition, students will submit weekly rosters of operative cases they have scrubbed into and clinic cases they have seen while on the Subspecialty Services. Please respect patient privacy and INCLUDE PATIENT INITIALS ONLY on submitted paperwork (do not include any patient identifiers such as date of birth or medical record number).
The History and Physical should include the following sections:
- Chief complaint (in the patient’s own words)
- History of present illness
- Past medical history
- Past surgical history
- Family history
- Social history and substance abuse history
- Complete review of systems (minimum 12 systems reviewed)
- Physical examination including vitals
- Laboratory and diagnostic studies if available
- Assessment (should include a differential diagnosis)
- Discussion (should include appropriate textbook and literature references)
The Clerkship Director will then review each H/P for content, accuracy, and discussion. In turn the students should be prepared to discuss the patients and their weekly rosters with the Director when called upon.
During this rotation, students will also be assigned to a week of night shift call. During this week, students will be exposed to all the surgical disciplines while assisting the junior and senior surgical residents performing in-house call. Students will be exposed to emergent and urgent general and subspecialty consultations and assist with trauma resuscitations. In general, students report at 6 PM nightly and are excused after rounds the following morning by 8 AM. Please refer to the call schedule for specific assignments.
At the conclusion of this 4-week rotation, students will be evaluated on their performance and enthusiasm in the subspecialty clinics, the history and physicals they submit and their preparation for the weekly Clerkship Core Lecture Series. Written evaluations by the Clerkship Director, Dr. Amir Berjis, will be provided.
The Department of Surgery has weekly conferences designed for resident education. It is recommended that third-year medical students rotating through surgery be present and participate in these conferences unless scrubbed into a case or responding to a trauma activation.
The Department of Surgery holds its resident-required conferences Monday mornings from 7:30 a.m.-noon. Students are required to be present for surgical Ground Rounds, Morbidity and Mortality Conferences, Journal Clubs, and Pre-Op Conferences. In addition, Kern Medical holds multidisciplinary conferences Wednesdays at 7:30 a.m. and Thursdays at noon. Students are encouraged to attend and participate in these conferences as well.
Third-year medical students also have a dedicated lecture series entitled Clerkship Core Lectures on Thursdays 4-6 p.m. A weekly topic will be discussed by selected general surgery faculty. Students are expected to read about each weekly topic prior to the lecture presentation. In addition, students on the subspecialty services will discuss their written history and physicals with the Clerkship Director. Participation in the Clerkship Core Lectures is mandatory. At the conclusion of the 12-week lecture series a formal written final exam in a format similar to the Surgical Subject Exam (SHELF) will be offered. Please follow this link for more information about the Clerkship Core Lectures.
Medical Student Orientation
Third-year medical students will have a mandatory orientation to the surgery clerkship on the first day of their rotation starting at 8 a.m. Room assignments for the orientation will be provided to you via email. A general outline about the clerkship will be provided. In addition, students will meet with the OR staff to learn about appropriate hand/arm washing and the sterile technique. Finally, introduction to the surgical patient will be presented with a review of the formal history and physical exam.
Clerkship Core Lecture Series
The Clerkship Core Lectures are mandatory for third year medical students rotating through surgery. Unless specified, these lectures are held Thursday afternoons at 4 PM to 6 PM. Students who are on night call are expected to be present for these lectures each week.
Each lecture series will begin with a faculty presentation and case presentations on a pre-determined topic that will last 45 minutes to one hour. Students are expected to read beforehand on that week’s topic and be prepared to actively participate when called upon.
The remaining time during this 2 hour mandatory conference is dedicated to oral student question and answer case reviews on previously reviewed surgical topics. Students are expected to read about each assigned topic prior to the lecture series. The aim of these lectures is to explore the understanding of the concepts, not the transmission of the content.
The final week of the 12-week lecture series will offer an opportunity for student feedback regarding the surgery clerkship and means to improve or enhance future students’ experience. This is optional for the medical student.
The recommended text is Essentials of General Surgery, 5th Edition by Peter Lawrence. Other similar text that provides a basic review of general surgery and subspecialty surgery may also be used at the student’s discretion.
All lectures and the final exam are conducted in Room 1135 adjacent to the Radiology File Room.
Week 1. Trauma, Burn, and Critical Care
Week 2. Pre-Operative and Post-Operative Care
Week 3. Diseases of the Gastrointestinal System, Part I
Week 4. Diseases of the Gastrointestinal System, Part II
Week 5. Diseases of the Breast
Week 6: Diseases of the Endocrine System
Week 7: Pediatric Surgery
Week 8: Cardiothoracic Surgery
Week 9: Vascular Surgery
Week 10: Surgery Case Studies (Informal Oral Exam)
Week 11: Final Written Exam at Sagebrush Testing Center (4 PM)
Week 12: Review and Student Feedback with Clerkship Director (*optional)
Students will be evaluated by faculty and residents with whom they have had sufficient contact to allow a valid assessment. Weekly meetings with the Clerkship Director will allow students to demonstrate their knowledge and clinical reasoning in the treatment of surgical patients. Finally, a written exam will also contribute to an objective assessment of the third-year medical student.
The clerkship will offer a composite evaluation and grade to the medical school that will be combined with the National Board of Medical Examiners (NBME) shelf exam results (which account for 20 percent of a student’s grade) to produce the final grade for the clerkship.
All students must also provide an anonymous evaluation of the 12-week rotation to the Clerkship Coordinator prior to the clerkship’s submission of the student’s final grade.
General Surgery (four weeks)
Students on the General Surgery Service will be evaluated at the conclusion of their four-week rotation by the chief resident of either Gold or Red Surgery. The chief resident’s evaluation will be made in conjunction with input from junior and senior residents who also have had direct contact with the student during the six-week period. The chief resident will submit a written evaluation that will account for 25% of the final grade that the clerkship will provide to the medical school.
Trauma Surgery and Critical Care (four weeks)
Students on the Trauma Service will be evaluated at the conclusion of their four-week rotation by the trauma attendings (Dr. Pakula and/or Dr. Skinner). The attending’s evaluation will be in conjunction with input from junior and senior residents who also have had direct contact with the student during the three-week period. The attending will submit a written evaluation that will account for 25% of the final grade that the clerkship will provide to the medical school.
Subspecialty Service and Call Coverage (four weeks)
Students rotating on the Subspecialty Surgery Services for four weeks will be exposed to pathology and surgeries not commonly seen on a standard General Surgery Service. Medical students will be directly evaluated by the Clerkship Director. The evaluation will be based on the submitted weekly history and physicals, performance during the weekly didactic lectures, and input from the Subspecialty faculty.
Final Exam (Week 11)
All third-year medical students rotating on the surgery clerkship will take a final written exam in Week 11. This computerized exam is made up of 40 shelf-like questions, covering topics discussed during didactics in addition to the expected reading during rotations in Trauma and Subspecialty Services. Students will have one hour to complete the exam. The exam will account for 25% of the final grade that the clerkship will provide to the medical school.
Feedback and Mid-term Evaluation
Faculty and residents are encouraged to provide students with regular constructive feedback on their performance throughout the clerkship. As a means of facilitating this process, students are encouraged to regularly solicit feedback from their chief residents regarding their performance. Questions like “How did I do today?” or “Is there anything specific that you’ve noticed that I could do better?” will help prompt supervising physicians and associated medical care staff to provide important constructive feedback.
At the 6-week mark of the clerkship, all students will undergo a formal mid-term evaluation that will highlight the strengths and weaknesses of each student. When necessary, remediation plans will be formulated and utilized to give students sufficient time in the latter half of the clerkship to improve on their clinical performance.
Please understand that our surgical faculty consider your time and experience on our clerkship very valuable. We will do our best to enhance your learning experience. Yet, an assessment of your performance on the clerkship is mandatory. These evaluations are considered final and cannot be challenged.
Vacation Requests, Excused and Unexcused Absences
This 12-week clerkship requires a full-time commitment from the medical student. Students on the clerkship are generally not allowed to take vacation, unless specifically allowed in advance by the Clerkship Director. Excused absences for medical leave, emergency family leave, and Step 2 CK/CS examinations are allowed once the request has been approved by the Clerkship Director. Unexcused absences may result in a formal warning letter and/or dismissal from the clerkship resulting in a failure grade.
Students must submit a completed form for requested time off to either the chief residents of general surgery, trauma, or the Clerkship Director. The Director must approve all excused absences. The form can be obtained from Medical Education or downloaded here.
Third-year medical student orientation to surgery clerkship is held on the first Monday of each 12-week rotation. A general outline to the clerkship will be presented, including the various requirements. Students will also have an opportunity to learn the basics of the operating room, including appropriate attire (scrubs, masks, etc.), hand/arm washing, and the sterile technique. Finally, an introduction to the surgical patient will be discussed.
A typical week on a third-year medical student clerkship will include a variety of resident and medical student conferences, general surgical and trauma clinics, and subspecialty clinics.
A typical weekly operative schedule is presented below.
Rotation schedules for medical students are created in advance of each rotation. Please bear in mind that great time and effort are taken to create the clinic schedules for each rotation and the medical student call schedule.
At this time, vacation is not allowed during your surgery clerkship. Emergencies and the like will be handled on a case-by-case basis. If changes are made to the call schedule between students, it is up to the students to present the changes to the Clerkship Director for approval.
Student Assignments and Call Schedules
Students are designated by a letter from A through R in the rotation and call schedules.
Approximately 2 weeks prior to the start of each 12-week rotation, student assignments and call schedules are made available through the Department of Medical Education and are posted in the Department of Surgery. Please note your letter assignment and review the call schedules carefully.