Surgery Resident Guidelines for Interacting with 3^rd year medical students

Overview of Clerkship Structure and Guidelines

DO's and DON'Ts when it comes to the students

Medical Student Guidelines for Call Schedules

The following guidelines have been outlined by Dr. Ellozy regarding the interactions of Residents and Students.

The General Surgery Clerkship for third-year medical students at Mount Sinai consists of:

• 3 weeks of General Surgery at Mount Sinai (on Team III, Team IV, Team V, Surgical Oncology, or Vascular),

• 3 weeks at Elmhurst (on Team I or Team II), and

• 2 week “exposure” (including rotations in Transplant, SICU, Orthopedics, Urology, ENT, Cardiothoracic, and Plastics).

The vast majority of the students’ interactions are with the residents over these short blocks of time, so we have set some general guidelines regarding what is expected. Keep in mind that the students see the residents as representative of the Department of Surgery and surgery as a whole, so the residents should do their part to keep the students involved, motivated, and interested.

Chief Residents:

1. Introduce self on first day of rotation if MS 3’s have not contacted you earlier
2. Explain team structure and functions of individuals: interns, seniors, chief, fellows, and attendings
3. Meeting with the students on the first day of their rotation is mandatory at which time the chief should explain daily routines, general expectations, and methods of evaluation
4. Meet with the students at least twice during the 3-week block for sit-down teaching sessions
5. At Elmhurst, process of how traumas are run and what roles students and residents may play should be explained on the first day of the rotation
6. Meet with students individually at the end of their 3-week block to discuss their overall performance. If a particular student has major deficiencies, such a meeting should take place earlier in the block to allow time for improvement.
7. Expectations of students:

a. Students should follow 2-5 patients daily

Included in this is seeing the patient in the ER if on-call or in the holding area prior to the OR (+/- with the resident), pre-rounding and presenting every morning, following-up on appropriate studies, labs, and consults during the day, and preparing for afternoon rounds if available.

Chiefs should be conscious of their students (and the rest of their team) as the day gets later and make arrangements for students not to stay for PM rounds if the chief is scrubbed until very late

                        b. Students should divide the cases amongst themselves the night before

                        c. Students will record the cases in which they participate

                        d. Students will participate in all conferences and their roles in individual team

    conferences should be explained by the chief at the beginning of the rotation

e. Students must attend Wednesday afternoon lectures but should return for PM   

    rounds (except at Elmhurst)

Senior Residents:

1. Introduce self and PGY level on first day of rotation
2. Clarify with other senior resident on team and all MS 3’s your involvement in determining the final grade/evaluation process
3. Explain the “senior role” on the team (i.e. explain how you see the “outside” and why you are not always at rounds)
4. Explain call night objectives and plan….make the senior call schedule available to MS 3’s for coordinating upcoming overnight calls
5. Sit with MS 3’s for at least 2 sessions over the 3 weeks (30-60 minutes each) and teach.
6. On a daily basis MS 3 should be with senior resident when meeting DAS pt’s in holding, the chart reviewed together, case discussed, indications elucidated, expectant pertinent anatomy reviewed, pertinent images reviewed on PACS.  Cases will obviously lead to guided reading assignment for MS 3 for above senior teaching sessions.
7. On call:
   1. Most teaching is by shadowing very busy senior
   2. Each MS 3 should have 1 pt to work up independently each night including a focused H and P and drafting of A and P before dismissed for night
   3. Review 1 plain film and 1 CT before being dismissed for night
   4. Students are required to stay at the hospital with you until 10 pm after which time they should be available by pager or cell phone for cases. Call at Elmhurst is overnight and the students will be off on post-call days.

DO's and DONT's when it comes to interacting with the Medical Students

** This has been adapted from The Resident, The Student, and The Competencies.  A Joint Project of the ASE / APDS.  March 2005

Medical Students Guidelines for Call

• 5 calls over the 3 weeks (4 calls if rotation ends with the Exam on Friday)
• All weekend days must be covered by students (except weekend after Exam)
• The weekend between rotations (ie between Sinai and Elmhurst) also has to be covered
• If two or more people on call during one day, it must be a Friday or Saturday (ie can only double up on Fri/Sat)
• Seeing consults and participating in emergent cases should be the priority.  Helping interns with floor work should be secondary.
• the call schedules must be posted

At Mount Sinai

• Call is usually less busy than Elmhurst.  Students are required to stay until at least 10pm or later
• See consults w/ the Senior resident on call, participate in late cases
• Expected to still come in for full day the next day
• If student stays all night in cases or doing other work (not sleeping in the call room),  excused the post call day after rounds (let chief know if you stayed all night)

At Elmhurst

• Call is overnight. 
• will be excused after rounds post call.
• Carry the Trauma Student Pager
• Help with procedures in the ER, see consults, participate in emergent cases