Learning Objectives

Throughout the clerkship, the student participates as an active and responsible member of the surgical team on the services to which he/she is assigned. He/She has the responsibility for taking a history, performing a physical examination, writing work-ups and participating in those diagnostic and therapeutic measures within the limits of his/her competence in the care of patients assigned to him/her. Such participation in patient care requires careful supervision of the student by the attending staff and resident staff of the service. The student will be expected to study and analyze the problems presented by his/her patients using the resources of the departmental personnel, laboratories and Health Sciences Library which are available to him/her. This type of self-directed education will be supplemented by lectures, conferences, rounds, seminars, tutorial sessions and directed reading. During the clerkship, the student is expected to develop cognitive, manipulative and attitudinal skills as a part of his/her continuing education in medicine in general and with surgical diseases in particular.

The objectives of the third year clerkship in surgery may be more specifically defined as follows (references to the UNC SOM Milestones can be found here:

Medical Knowledge:

Students must demonstrate knowledge of established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge in patient care, specifically:

• Apply knowledge of physiology and pathophysiology in patient care (UNC SOM Milestones 3001-3003)
• Use knowledge of morbidity, variability & cost in diagnostic testing (UNC SOM Milestones 3004-3006)
• Bring knowledge of social, developmental, and behavioral variations to patient care (UNC SOM Milestones 3007-3013)

Patient Care/Clinical Skills:

Students must be able to provide care that is compassionate, appropriate, and effective for treating health problems and promoting health, specifically:

• Obtain an appropriate history without manipulation or coercion (UNC SOM Milestones 3014-3016)
• Perform an age- and gender-appropriate exam, identifying major abnormalities (UNC SOM Milestone 3017)
• Understands risks, benefits, indications and informed consent process for procedures (UNC SOM Milestones 3018-3019, 3048)
• Creates an appropriate care plan, including diagnostic testing, treatments, preventive care and considering shared decision making, risk assessment, cost, patient goals, acuity, and evidence-based principles (3020-3030), including end-of-life issues, medication reconciliation (3028) and pain management when appropriate (3033-3035)
• Demonstrates cultural and gender sensitivity in interactions with patients and members of the health care team (UNC SOM Milestones 3036-3037)

Interpersonal and Communication Skills:

Students must demonstrate interpersonal and communication skills that facilitate effective interactions with patients and their families and other health professionals, specifically:

• Communicates effectively and empathetically with patients, families and health care professionals (UNC SOM Milestones 3038-3042), including oral presentation of history and physical, summary of findings, assessments and plans.
• Generates appropriate written medical documents, using EMR, (UNC SOM Milestone 3043) including accurate, comprehensive progress notes
• Collaborates with other members of the health care team (UNC SOM Milestone 3044)

Professionalism:

Students must demonstrate a commitment to professional service, adherence to ethical principles, sensitivity to patients, and maintain personal health and well-being, specifically:

• Demonstrate honesty and integrity (UNC SOM Milestones 3045, 3050)
• Identifies ethical challenges in the care of patients, including conflicts of interest (UNC SOM Milestone 3049)
• Demonstrates healthy work-life balance and appropriate prioritization of patient care needs over personal needs (UNC SOM Milestones 3053-3054)
• Sets personal learning objectives and seeks feedback (UNC SOM Milestones 3055, 3056)
• Reflects on feedback and adjusts behavior (UNC SOM Milestones 3057, 3058)
• Is punctual, dresses appropriately and demonstrates respect for others

Practice Based Learning:

Students must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their practice of medicine, specifically: Exhibits characteristics of a self-directed learner:

• Assesses the medical literature to answer clinical questions and creat plans of care and acknowledges the conflicts between research and clinical responsibility (UNC SOM Milestones 3059-3061)
• Identifies safety, risk and quality-of-care issues and strategies for improvement (UNC SOM Milestones 3063, 3064, 3071, 3075)

System-Based Practice:

Students must demonstrate an awareness of and responsiveness to the larger context and systems of health care and the ability to call on system resources to provide care that is of optimal value, specifically:

• Use the electronic medical record for record keeping, entering orders and accessing diagnostic results (UNC SOM Milestone 3065)
• Participates in the care of complex patients by using flow sheets, communicating with consultants, attending multidisciplinary conferences, and/or arranging access to community resources (UNC SOM Milestones 3066-3070)
• Understand the roles of different providers in multidisciplinary patient care (UNC SOM Milestones 3072-3073)

Managing Health of Populations:

Students must demonstrate an understanding of the management of populations, for both specific clinical populations and to diseases and conditions important to North Carolina and the US.

• Addresses access to care, cost and quality in populations receiving care (UNC SOM Milestone 3074)
• Identifies the impact of health disparities and financial policy on disease and how to address these disparities (UNC SOM Milestones 3077-3078. 3076)

One45 Log Requirements

In addition to meeting these objectives, there are certain patient and skills log requirements that pertain to the Surgery clerkship. Please click here to see these requirements.

Formative Assessment

All students will receive formal mid-course feedback from the course director, but we also encourage students to seek critique and constructive criticism regarding their performance during their clinical rotations from the attending staff and the house staff with whom they work. This feedback is available from the faculty and chief resident on each rotation during the clerkship and students are encouraged to seek this direct feedback in a timely manner. Students also are encouraged to review their clerkship records during the clerkship. Should the student choose to do so, a meeting with the Clerkship Director can be arranged at the conclusion of the clerkship.

Summative Assessment

The degree to which these clerkship objectives are achieved by the student is determined by evaluating the student's performance within each of the Core Competencies by a combination of specific assessment modalities, including:

• Review of each student's patient workups and progress notes by members of the attending staff house staff.
• Interaction between the student and the attending staff and house staff in the clinical care of patients.
• Ongoing assessment of the student's presentations on rounds and in conferences.
• Interaction between the student and attending staff and in lectures, conferences and tutorial sessions.
• Compilation of the individual evaluations of the student rendered by members of the attending staff and house staff.
• Written examination at the end of the clerkship (National Board of Medical Examiners Part II Surgery Subtest).

The final clerkship grade is accompanied by a narrative statement recording the student's overall performance during the clinical rotations, in tutorial sessions and on the written examination.