SURGERY. Class Year: 2012 Clerkship Rotation Evaluation Results SI. Site: Ingham Regional MC. Service: Caseload and Management of Patients

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1 Site: Ingham Regional MC Service: Class Year: Clerkship Rotation Evaluation Results SI Caseload and Management of Patients In general, there was an appropriately diverse mix of patients (including race and ethnicity) seen on this service to meet the clinical training objectives. NA SD D N A SA N= N % N % N % N % N % N % 6 0% The amount of patient care responsibilities assigned to me were just about right for my current level of training. 70% In general, I had an opportunity to develop procedural skills commensurate with my level of training. 7 I was given ample opportunity to become involved in learning about management of patient cases. 0% 9 I felt supported and encouraged to present a differential diagnosis and treatment plan. 0% 0% 7 Expectations/Learning Objectives Standards for my expected level of performance (how I was to be evaluated) on this rotation were made clear to me at the outset. % % On this rotation, the course protocol and its learning objectives were used by my preceptor to help me focus on content and/or skills that I was expected to master. 6 0% % There were adequate didactics on this service to enhance my existing knowledge base; i.e. conferences were scheduled regularly and occurred as scheduled. 0 0% The information presented on this rotation was presented at a pace and at a level that was consistent with my existing knowledge base % Resources There were sufficient educational resources (computers, books, journals, & other library materials) available to me on this rotation. I had access to educational resources at times that were convenient to me. 7 Eval Data from: 7//0 to: 9// Page Print Date: /9/

2 Site: Ingham Regional MC Service: Class Year: Clerkship Rotation Evaluation Results Osteopathic Principles and Practice NA SD D N A SA N= N % N % N % N % N % N % On this service there were facilities and opportunities available to support learning about osteopathic manipulative medicine (OMM). 0% % 0% Faculty knowledgeable in the appropriate use of OP&P in case management were available to me as needed. 0% 0% % I had opportunities to use OMM on this service. 6% 6% 6% % 6% When seeking out opportunities to apply OMM, I felt supported by the faculty here. 7 7% % % % Preclinical Preparation The basic science content I learned in Year assisted me in learning from the experiences I encountered on this service. 0% The systems biology content I learned in Year assisted me in learning from the experiences I encountered on this service. 6 0% In general, the material I learned in Years & had little clinical relevance to what I encountered on this service. % 0 0% 0% % Supervision/Feedback I received timely feedback about development of my clinical skills (e.g. charting, physical exams, history taking, and DPR, etc.). 0% 0 0% On this service, I never quite knew where I stood in meeting expected outcomes. % 9% % % 9% On this service, there was always someone available to answer my questions when I had them. 0 0% The post-rotation examination reflected the core content areas as described in the course protocol. Eval Data from: 7//0 to: 9// Page Print Date: /9/

3 Site: Ingham Regional MC Service: Class Year: Clerkship Rotation Evaluation Results Professionalism I was treated as a professional by those supervising my student-physician role on this service NA SD D N A SA N= N % N % N % N % N % N % 6 7 My supervising faculty on this service modeled physician-patient interactions on this service in ways I would like to emulate. % 9 7 Issues of professionalism were included as a point of discussion by faculty on this rotation. 0% 9 Procedures I feel prepared to insert a Foley catheter (male and female). 0% 0% 6 0% 9 I can satisfactorily perform a surgical hand scrub. 6 0% 70% I am able to gown and glove alone and with assistance. 7 6 I can perform instrument ties. 9 I can perform one-handed surgical ties. 9 I can perform surgical knots wearing surgical gloves. 0 0% 0 0% I am able to properly change surgical dressings, both clean and contaminated. 0 0% I am able to suture and staple skin using sterile technique. 7 I am able to perform the proper exam of an acute abdomen % II am able to prep and drape a surgical field. 0 0% 0 0% Eval Data from: 7//0 to: 9// Page Print Date: /9/

4 Site: Ingham Regional MC Service: Class Year: Clerkship Rotation Evaluation Results I am able to administer local anesthetic. I am able to administer peripheral IV insertion. NA SD D N A SA N= N % N % N % N % N % N % 6 0% I am able to perform nasogastric tube insertion. 0% 0% 0% I am able to perform the patient teaching, incentive Sprirometry, drain care, etc. 9 Overall Assessment This rotation offered a positive learning experience and stimulated my interest in this specialty of medicine. My experiences on this rotation stimulated my commitment to become a physician. 6% 9 7% 7 7% My experiences on this rotation stimulated my commitment to become an osteopathic physician. 6 0% 6 0% Due to this rotation, I am comfortable caring for surgical patients including pre-operative and post-operative care. % 9 7% 7 7% Eval Data from: 7//0 to: 9// Page Print Date: /9/

5 Ingham Regional MC Caseload and Management of Patients At least with the attendings I was assigned to, there was usually a time crunch that was not condusive to them really going through the medicine topics behind the surgeries they did with me. I would try to find out the diagnosis and look stuff up a little on my own, but time was short. Expectations/Learning Objectives Outside of the morning minute didactic lecture during morning report, there was not very much didactic interaction at all. Resources Ingham needs to review its new policy on after hours library use. When arriving at the hospital at am, it is difficult to not have access to the library. It is a shame if some students messed this up for the entire hospital. Considering the IRMC library is only open 9- M-F, no, resources were not available at convenient times. Osteopathic Principles and Practice The time necessary for OMT in a same-day-surgery unit was an unrealistic expectation. Supervision/Feedback For this rotation the resident I worked with was not very good at communicating what I should do, what was expected, or all that helpful with answering questions. Professionalism Dr. Fredline is a fatastic teacher, and role model. Procedures I was kept very busy with the physicians and same day saurgery porcedures. There were no cases I was involved with where the patient needed a Foley and no obvious times for me to find patients to do so. I know I am expected to search out these opportunities, but I felt the Foley, IV and NG tube should be taught to us rather than us trying to convince nurses to let us practice for the first time on sick patients. Trying to learn these procedures on my own was frustrating and a source of great anxiety. The fact is that at Ingham, it is Anesthesiology that does the NG tubes and the IVs. It was difficult to find opportunities to do these since the students and residents on those rotations also needed to learn and I did not want to take away from their opportunities considering they are actually supposed to learn that on their rotation. I think this needs to be reevaluated. Also, at Ingham, almost everyone uses one-handed ties and the surgeons want the students to use this technique. Therefore, it was very difficult to get in the two-handed and instrument ties needed for the checklist on angel. A lot of things I was only able to perform once or twice and would definitely need more practice to get more confidence. I am able to administer local anesthetic. Eval Data from: 7//0 to: // Page March 9,

6 The content of the online materials in the Angel course for Surgery reviewed the procedures I needed to be successful on my surgery rotation. Yes, to some degree. But I feel that it was inadequate. Yes, this information was very helpful. true Not really. They were helpful. Agree Yes. A thorough review of the procedures needed for this rotation is necessary during the campus orientation. YES. I think opportunities to do NG tubes or IVs, things that are "necessary" for multiple rotations but have few opportunities should be reviewed. A review of the basics: surgical hand scrub, inserting IVs, Foleys, and NG tubes would be very helpful. No true Its not really useful unless you start surgery the next day. Tying sutures and scrub technique was forgotten by the time I started surgery. Yes. If this is based on the checklist that we needed to complete during the rotation, then. Honestly before this rotation I had no idea how to insert a Foley or a peripheral IV, or even how to prep and drape a field. It would be better served to have the first morning of surgery include a mini orientation than one day multiple months beforehand. Agree NA. I feel that the hospital orientation covered what I needed to know to be successful in this rotation. Not especially... but then the orientation was about the hospital overall, not just this rotation. Yes, I think the scrub clinic if very important especially. true I disagree. The residents really were very helpful in orienting me to the hospital. Not really. Eval Data from: 7//0 to: // Page March 9,

7 Really the only thing they covered regarding the surgery rotation was how to scrub in. A lot of the tips and tricks that I learned to be successful in this rotation were from colleagues who had the rotation before me, and I learned from their/my mistakes. My hospital orientation was months prior to this rotation. Agree NA. Overall Assessment I learned a lot about procedures and OR "etiquette" and that sort of thing. I did not learn much at all about the medicine behind surgery cases or how to manage patients. My attendings and resident just sort of did things while I stood there rather than try to teach me as they went. We always were rushing to get stuff done, so I didn't feel comfortable or encouraged to ask many questions. This was a very stressful rotation because some attendings were very negative and critical in the OR. Overall Summary - Please complete the following sentences. The most beneficial experiences, classes, assignments, or activities in all my on-campus MSU/COM courses/experiences, which facilitated my performance on this clerkship rotation, were: Anatomy lab. Suture clinic- although I wish there were more. Not the one during respiratory, but the one from the surgery club where we actually got to take the practice yarn and stuff home. Systems courses Suture clinic Anatomy gi, anatomy Suture clinic and ob/gyn rotation helped with being in the OR Suture clinic The residents and attendings provided a professional and educational environment in which students can learn. Acids and bases, anatomy, GI The video on angel about scrubbing was helpful Anatomy class was most helpful. This rotation could have been improved by: Suture clinic earlier. Guided learning for procedures that could potentially harm a patient. A re-evaluation of the necessary tasks performed by MSUCOM. Using part of the hospital orientation toreviewthe procedures we are expected to perform on this service setting it up so that the student could rotate to a different attending/resident each week. I felt like I was trapped on a service that did only abdominal/bariatric surgeries and missed out on a lot of other types of general surgery procedures. Also, some attendings/residents are naturally better about teaching so that it would have been a benefit to my learning to have some time with them as well. Allowing students to perform more procedures Eval Data from: 7//0 to: // Page March 9,

8 More OR time More OR time. More responsibility. More educational/teaching time. I honestly felt as if I learned nothing on this rotation. Working with Dr. Ko was very beneficial, however it would be nice if the attendings had been more open to taking a few minutes to teach rather than expect students to be 00% knowledgeable about a subject. Some attendings being more respectful of all personnel in the OR. none. The thing(s) I like most about this rotation was (were): Pre and post op care of the patients. Getting a first hand view of the anatomy and pathology. The residents were great. They wanted me to learn and they were always ready to answer questions I had. The attendings and residents were very good teachers, excited about medicine, and were extremely supportive and encouraging. being in the OR and watching surgery and being involved in ways that are consistent with what i've been taught. Good instructors, hands on learning the residents were a strong, connected group. OR time, breast cancer clinic, breast tumor board Getting a live look at human anatomy. The residents are hardworking and are really very fun. The easy-going nature of Dr. Deppen and the residents I was with. It's a high-pressure environment, but I don't think that pressure needs to get transferred to the student - so I think a good job was done in making me feel at ease and comfortable with whatever I was asked to do. Working with Dr. Ko. Scrubbing in and participating in many interesting surgeries. The resident was excellent, very knowledgeable and encouraging. He took time to explain things and talk about cases. The level of hands on time the student gets. The surgical staff was very accommodating to students and were willing to help my education. Eval Data from: 7//0 to: // Page March 9,