Table of Contents

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Structure of the clerkship

1 week rotations

These rotations are meant to expose you to the breadth of surgery. One week can feel short but you should be able to see a selection of representative cases and disease processes. It is critical to start the week ready to go. You should know where and when to meet your team before the first day. Please review the service descriptions at the end of this document.

Call & Night float

You will take call with the on-call resident team. Generally call teams are comprised of 4 residents. A chief resident (R4 or R5), a consult resident (R2 or R3), a SCU resident (R2) and an Intern (R1). You will join this team for the entire shift and your assignments and responsibilities will be assigned by the chief resident. You should expect to see an assortment of emergency general surgery consults and trauma activations as well as a variety of operative cases.

Daytime call

Where to report in the morning:

If in doubt, find out who is the chief resident for the day you are on call (Amion.com) and contact them. They can give you guidance on where and when to meet.

 

Alternatively, you may check with your team that you have been assigned to that week and simply join them for weekend rounds. You can see who is rounding on your service at surg.me/rounds. After rounds are done you should check in with the chief resident for general expectations for the day.

Night call and Night float

Where to report:

Evening call and night float begin each night at 6pm. Generally, the team congregates around the surgical call room at the beginning of the shift.

Expect to stay around for much of the night until you are dismissed (rarely, on especially busy nights you may stay the entire night). Please note that if you are uncomfortable leaving the hospital in the middle of the night, security will gladly walk you to your car or nearby home. There are also call rooms available.

 

How you are evaluated

Clinical performance

Your clinical performance is determined by evaluations filled out by clinicians that you work with. You should review the evaluation form for the parameters that are evaluated. Each evaluator may not witness all of these attributes (N/A is common).

 

You are expected to hand these evaluation forms out to anyone on your team who can give any evaluative feedback. Most of these will come from residents and attendings however it is also normal to have evaluations from NPs, PAs, nurses, respiratory therapists and pharmacists.

 

Most of the evaluations are delivered by the student to the evaluator. When possible, handing these over in person is preferable because it encourages face-to-face feedback. At the end of the rotation we will review any evaluations that are received (usually about 6 evals) but many evaluations are often received after the clerkship ends.

 

Oral presentation

You will perform a short oral presentation during your clerkship. This is evaluated as a part of your clinical performance. This is a chance to teach the clerkship students and clerkship director about a topic of your choosing. These presentations should be about 10 minutes long. Do not summarize a chapter, these should answer a clinical question that you have. For example: a bad topic would be “inguinal hernias”, a better topic would be “incidence and management of post-operative neuralgia after inguinal hernia repair”. Often these are case based presentations but they can also touch on the humanities and history in surgery. Most important is that they are clinically relevant. You will be evaluated on the content and presentation of the topic.

Oral exam

Format

Three patient scenarios over zoom with Tufts faculty

 

Evaluation

Each question is scored according to its own scoring rubric supplied by Tufts.

 

How to study

Practice. You should practice patient scenarios with each other and with residents or even by yourself. The breadth of topics is fairly similar to what you should have covered on WISE-MD cases

Written exam

Shelf exam

Service Descriptions

Breast

The breast rotation will give students an immersion in both benign and malignant breast surgery. You will have the opportunity to see complex interdisciplinary and shared decision making in the office as well as the surgical care of these disease processes. Most of your time will be at the Breast Care Center and Scarborough Surgery Center so be prepared to travel.

 

Staff: Dr. Desjardin,  Dr. Teller, Dr. Greatorex

 

Common diagnoses/cases:

Breast cancer

Benign breast disease

Lumpectomy

Mastectomy

Colorectal

This group cares for a variety of colon and rectal diseases. You will be exposed to large open, laparoscopic and robotic colon resections as well as a variety of anorectal pathologies.

 

Attendings

Colorectal: Drs., Roberts, Mack, Lee, Audett

 

Casco Bay Surgery office location

 

Common diagnoses/cases:

Colon and rectal cancer

Diverticulitis

Ulcerative colitis

Crohns

Hemorrhoids

Fissure

Anal Fistula

Rectal prolapse

 

Emergency General Surgery (EGS or ACS)

This service is one of the core experiences in general surgery. It serves as the primary, non-subspecialty service for all general surgery consults and admissions. Here is where you will encounter all of the “bread and butter” emergency operations and disease processes.

 

Common diagnoses/cases:

Appendicitis (appendectomy)

Cholecystitis, cholangitis, pancreatitis (cholecystectomy)

Small bowel obstruction (lysis of adhesions)

Diverticulitis (Sigmoid colectomy, Hartmann’s procedure)

Ischemic colitis

Crohns

incarcerated/strangulated hernia

Enterocutaneous fistula

Skin soft tissue abscesses

 

Night Float

Night float is routinely one of the most highly rated rotations of the clerkship. The night float is the front line for all general surgery and trauma at night. Expect a steady stream of consults, trauma evaluations and OR cases to keep you busy.

 

You should integrate with your team and aim to contribute in any way possible. This is a chance to perform primary secondary surveys on trauma patients and see consults. Work with your chief residents to set expectations and goals for the week.

 

There is no office associated with night float

 

Note that your night float rotation ends at 6am on Friday (your resident team will work on Friday night but you do not)

Office Week / outpatient surgery

Office week was created to get students exposure to the outpatient world of surgery. You will primarily be assigned to our Minimally Invasive Surgery (MIS) service but you will also have a chance to attend vascular surgery outpatient offices, wound care clinic and Dr. Hallagan's office hours. 

Daily schedule 

Monday

AM: MIS

Join your team for rounds and attend any morning cases

PM: Dr. Brady’s Office (when available)

            Time: After lunch (12-1pm)

            Location: Casco Bay Surgery

            Staff: Dr. Tom Brady

            Procedure: Arrive at Casco Bay surgery offices after you have had lunch and ask for Dr. Brady. Dr. Brady is a hernia specialist. He sees consults from about 10-4:30pm or so.

 

Tuesday

AM: Hallagan office

            Time: 8:15am

            Location: 887 Congress st Suite 400 (fourth floor)

            Staff: Dr. Hallagan

            Procedure: Meet Dr. Hallagan for a day of “bread and butter” general surgery consults in the office. Expect to see patients independently, present them and write notes. Office can be reached by taking the skybridge across congress st (Garage level G down to B). After you cross the bridge, take the elevator to the fourth floor. Ask for Dr. Hallagan at the front desk.

 

 

Wednesday

MIS            

 

Thursday

MIS/didactics

 

Friday

AM: Breast center

 

Pediatrics

Pediatric surgery is an incredibly varied and valuable educational rotation. Here you will see a wide spectrum of pediatric surgical disease and also be exposed to some of the best educators in the department.

 

See this document for further details

 

Common diagnoses/cases:

FEN

Pyloric stenosis

Hernias/hydroceles

Rotational anomalies

Appendicitis

Anorectal malformations

Biliary atresia

Choledochal cysts

Congenital diaphragmatic hernia

Cryptorchidism

Duodenal atresia

Esophageal atresia / Tracheoesophageal fistula

Gastroschisis / Omphalocele

Hirschsprung's disease

Intussusception

Meckel’s diverticulum

Neuroblastoma

Necrotizing enterocolitis

Tracheal / Esophageal foreign body

Wilms tumor

 

SCU/Trauma

SCU is an incredibly content dense rotation. Sometimes this can feel overwhelming however the approach to and management of critically ill patients is a fundamental part of surgical training. During this rotation you will become part of a busy surgical critical care team managing a wide variety of illnesses. The majority of patients are trauma patients however you will also see a number of general surgical and vascular patients as well. While on SCU you should respond to trauma activations (all level 1 and level 2 as able).

 

Your team: You will primarily work with the residents assigned to SCU. There is always a surgery resident however often you will be with anesthesia and EM residents as well. You will also work closely with APPs and pharmacists.

 

You should plan on taking on 1-2 patients as your own by the end of the week. Work with your residents on choosing which patients have educational value. You should treat these patients as your own- follow up on tests, procedures and check in with families.

 

Morning rounds are the epicenter of the SCU experience. You will be expected to perform a system based presentation of your patients during rounds. 

 

During this rotation you will carry the Trauma pager. You should respond to any trauma that you are able to. You will also have time to attend trauma cases in the operating room.

 

Common diagnoses/cases:

SICU

Respiratory failure/ ventilator management

Shock

Procedures:

Tracheostomy

Percutaneous endoscopic gastrostomy (PEG)

Central line

Arterial line

Chest tube

Dressing changes

Trauma

Exploratory laparotomy for trauma (eg splenectomy)

Damage control surgery

Neck exploration

cricothyroidotomy

Resuscitative thoracotomy

Chest tubes placement

VATS

Rib plating

 

Surgical Oncology

This is the primary service for the surgical management of malignancy. There is a very busy thyroid cancer practice (Dr. MacGillivray) but also a large volume of intra-abdominal and soft tissue oncologic surgery performed.

Attendings: Drs Royal, Fitzgerald, Macgillivray

 

Common diagnoses/cases:

Thyroid cancer

Parathyroid diseases

Pancreatic cancer

Whipple procedure

Colon cancer

Metastatic cancer

Melanoma

Sarcoma

GIST

Thoracic

Summary

The thoracic service will expose you to a variety of benign and malignant thoracic diseases. It is a fairly small service but between the office and OR you will see a good variety of patients.

Please note: on weeks when there is no resident (eg vacations) it can be challenging to navigate the service. During these times, I may advise switching to a different service.

 

Common diagnoses/cases:

Lung cancer

GERD

Hiatal hernia

Esophageal cancer

Esophagectomy

VATS

Thoracotomy

Lung resections

 

Trauma

Your trauma exposure will be primarily be through you time on night float, in the SCU and on call. You should expect to see many trauma resuscitations and you should be able to participate in the primary/secondary survey in select patients.

 

Common diagnoses/cases:

Exploratory laparotomy for trauma (eg splenectomy)

Damage control surgery

Neck exploration

cricothyroidotomy

Resuscitative thoracotomy

Chest tubes placement

VATS

Rib plating

 

Urology

The urology service offers exposure to a variety of urologic disease processes.  You will be assigned to the resident team led by a chief resident who will coordinate your schedule.

Vascular

There are 2 busy vascular services in the hospital.  You will be assigned to one of them with a group of vascular and general surgery residents.  Expect to see numerous open and endovascular operations and participate on a busy inpatient service.  You should not attend vascular office well on your vascular rotation.  You will have exposure to outpatient vascular patients during your office week.

 

Common diagnoses/cases:

Limb ischemia

Angioplasty/stents

Carotid disease ( carotid endarterectomy)

Lower extremity bypass

Aortoiliac occlusive disease

AAA (open vs endovascular AAA repair)