Surgery - 3rd Year

The rotation consists of a six-week clinical experience as a junior member of the surgical team, combined with didactic instruction including problem-based learning, case presentations, and a series of lectures delivered at Jefferson Medical College. The clinical rotation is an opportunity to experience the gamut of common general surgical problems as well as the range of surgical procedures. The rotation includes exposure to transplant surgery, vascular surgery, and cardiothoracic surgery.

The third-year student splits his or her six-week rotation on two separate services consisting of three to five attending physicians, a chief resident, and three other junior residents. Students are expected to perform patient evaluations, write appropriate orders, and follow their patients through surgery and postoperative management. Clinical evaluation skills, introduction to and practice of technical surgical skills including suturing and minor procedures, and the understanding of anatomy are stressed.

Didactic Experience

Patient evaluation and problem-based learning and conferences are held on a weekly basis throughout the six weeks. A didactic lecture series is held at Jefferson Medical College, usually on Saturday mornings. Attending physicians from Lankenau and Bryn Mawr Hospitals proctor the patient evaluation and problem-based learning conferences. In addition, various multi-specialty conferences are held throughout the course of the rotation, including Oncology, Radiology, and GI conferences. The didactic experience should provide a broad exposure to all surgical problems as well as improve clinical evaluation skills.

Average Patient Load

Third-year medical students will evaluate patients in the emergency room, preoperative patients, and hospital admissions. The number of primary patient evaluations varies with the ability of the student but ranges between four and ten per week. Students usually follow three to five patients on their teams. Both junior and senior residents review the patient evaluation and provide feedback, as well as assist in writing orders. The student is responsible for follow-up evaluations and progress notes on his or her patients during their stay in the hospital. Teaching rounds are performed by the residents as well as the attending staff.

Preceptorship

The third-year student is not assigned to any one physician as a preceptor, but has access to junior and senior residents in each service, as well as the attending staff. Experience is gained both on the wards and in the operating room. Students are considered part of the team and receive the same attention in terms of education as the resident staff.

Work Hours

Due to the nature of a surgical rotation, duty hours vary considerably. Since the surgical experience involves not only time on the wards evaluating patients, but also a significant amount of time in the operating room, exact start and finish times cannot be guaranteed. Sign in rounds each morning for each team occur at 7:00 a.m. and patients are usually seen prior to this time. Sign out rounds in the evening usually occur at approximately 5:00 p.m., but on many days OR cases and emergencies may delay the time for sign out. Third-year students are not expected to come to the hospital on Saturdays or Sundays unless they are on call. However, the lecture series at Jefferson Medical College usually involves Saturday morning lectures.

Night Call

Night call for a third-year student will occur no more often than every third night. During the call, the third-year student is expected to see consults in the ER, admissions to the hospital, and emergency cases in the OR. This experience generally requires a third-year student to remain in the hospital overnight. Overnight sleeping quarters are available.

Number of Students on Rotation

There are usually three to five third-year medical students at Lankenau Medical Center during each six-week block. There may also be fourth-year students on rotation during any of these six-week time slots.

Student Expectations or Learning Objectives

See attached.

Description of a Typical Day

A typical day for a third-year clerk in surgery begins at approximately 6:00 a.m. Following round on his or her patients, sign in with the team occurs at approximately 7:00 a.m. All patients on the team are discussed at that time. Conferences are held on Tuesday and Thursday mornings following sign in and include patient management conferences. Rounds then occur with the attending staff. Students assigned to cases in the OR should be present 15 minutes prior to the procedure. Operations occur Monday through Friday beginning at 7:30 a.m. Following attending rounds, students will either be in the OR, evaluating new patients, performing procedures on the ward, or revisiting patients on the service. Educational conferences are scheduled on Tuesdays and Thursdays at noon, as well as other afternoon conferences. Sign out rounds with each team usually occur at approximately 5:00 p.m. However, there may be many reasons for staying later than 5:00. There are many opportunities for learning throughout the day and the student that is enthusiastic, inquisitive, aggressive, and independent will take away what he or she needs to learn from the surgical rotation.

Contact Information

Please contact the Department of Surgery at 484-476-2169 with your inquiries about the clerkship.