Dates Offered March 13 – April 22, 2023 (6 wks)

Anatomy/Surgery Intensive (ASI)

PREREQUISITES AND PLACEMENT IN THE CURRICULUM: Students must have completed all M3 Core Clerkships and have M4 status. Preference will be given to students matching to General Surgery. Any remaining slots will be available on a first-come basis to those matching to other surgical specialties and to Interventional Radiology and Emergency Medicine.

PURPOSE: This course is designed for the M4 student pursuing a career in a surgical discipline or in a discipline involving significant interventional procedures, such as interventional radiology or emergency medicine. It is intended to extend the fund of anatomic knowledge through twice weekly, specialty-specific dissections of cadavers, focusing on anatomical relationships required for the practice of surgery or interventional procedures. As a second component, it is intended to provide exposure & practice in the fundamentals of laparoscopic and robotic surgery and confer certifications as set forth by the American College of Surgeons (ACS) so that the MD graduate is fully prepared to handle a surgical internship.

COMPETENCIES:

  1. Identify normal anatomic structures and their spatial relationships as revealed by en face and sectional cadaver dissection. Includes some interventional procedures on the cadavers.
    2. Differentiate the spectrum of normal anatomic variation from pathologies
    3. Recount and describe some key pathologies associated with particular organs or anatomic sites
    4. Correlate normal spatial anatomy to its representation in the various medical imaging formats as revealed in assigned case study presentations.
    5. Identify (diagnose) major pathological manifestations in body systems as revealed by medical imaging during case study presentations, eg, hemorrhage, inflammation, neoplasia, cysts, effusions, calculi, herniation, penetrating/blunt trauma
    6. Perform the necessary skills to accomplish airway management including endotracheal intubation, cricothyroidotomy, open tracheostomy, percutaneous tracheostomy
    7. Perform the necessary skills associated with Advanced Trauma Life Support and receive certification
    8. Identify the Principles of Laparoscopic Surgery including Laparoscopic Equipment, Energy Sources, OR Setup, Pneumoperitoneum and Trocar Placement, Post-operative Complications; gain initial familiarity with the skills required for the Fundamentals of Laparoscopic Surgery taught in residency
    9. Identify the conditions required for a minimum of 8 different methods of treating wounds including skin grafts, biologics
    10. Perform subcuticular and interrupted sutures according to ACS/APDS/ASE standards of competency
    11. Perform knot tying according to ACS/APDS/ASE standards of competency
    12. Perform Urethral Catheterization as per ACS/APDS/ASE standards of competency
    13. Identify the principles of control of bleeding and perform proximal and distal control of vessels
    14. Identify pericardial tamponade and demonstrate the steps required for treatment
    15. Perform Ankle Brachial Indices with a Doppler
    16. Perform Central Venous access using ultrasound, peripheral IV, arterial line, and IO IV according to competency checklist
    17. Identify the Principles of Robotic Surgery including Robotic system Advantages, surgeon’s console, Remote Manipulator Arms, Monitor Interface, Instruments, Energy Sources, set up and Calibration, positioning components, docking/instrument insertion; gain familiarity with the Robotic Trainer for the development of manual Skills
    18. Perform in a team of two or three M4 students: an open laparotomy, splenectomy, obtain hemostasis in a liver laceration, and perform wound closure in a pig lab
    19. Perform a FAST scan on a series of simulated conditions and furnish an accurate diagnosis
    20. Satisfactorily treat life threatening post-operative conditions including the use of ACLS in simulation
    21. Perform as a team to get an emergent patient to the operating room, perform a time out, and prep and drape the patient for emergent surgery
    22.Perform as a team to identify critical medical errors and identify next steps to mitigate the errors including discussion with family
    23. Identify, gather, set up minor surgery without any assistance and perform a mock excision of a small lesion including local anesthetic, skin incision and skin closure as per ACS/APDS/ASE standards of competency
    24. Identify surgical instruments as defined by the ACS/APDS/ASE standards of competency
    25. Demonstrate the ability to suture and secure a chest tube, a Jackson pratt drain, G-tube and identify next steps if a tube falls out in various clinical scenarios
    26. Demonstrate the ability to describe an adverse event to a family member and next steps as per ACS/APDS/ASE standards of competency
    27. Demonstrate the ability to write admitting orders, transfer orders to the ICU, transfer orders to the floor from the ICU, and discharge orders as per ACS/APDS/ASE standards of competency
    28. Perform patient handoffs and the I-PASS method as per ACS/APDS/ASE standards of competency
    29. Identify sepsis and initial steps in the first hour of treatment
    30. Identify antibiotics and antibiotic strategy by organ system and condition
    31. Demonstrate competency in a post-operative fever work-up
    32. Identify anuria and oliguria and their treatments
    33. Identify acute mental status change post-operatively, causes and treatments
    34. Identify the treatment of post-operative chest pain and arrhythmias
    35. Identify the treatment of post-operative electrolyte imbalances and glucose management
    36. Identify and define the treatment for an ischemic extremity
    37. Assess post-operative pain and identify an appropriate management plan
    38. Identify acute respiratory compromise post-operatively and determine next steps in treatment
    39. Identify Shock and associated treatments as per ACS/APDS/ASE standards of competency
    40. Perform informed consent as per ACS/APDS/ASE standards of competency
    41. Perform death certification as per ACS/APDS/ASE standards of competency
    42. Perform discharge planning as per ACS/APDS/ASE standards of competency

INSTRUCTIONAL FEATURES:

I) Large Group Discussions: Weekly whole-group case presentations/discussions will be assigned that focus on surgical cases correlated with the cadaveric dissections.

II) Small Group Discussions: Students will break into small groups to discuss various topics throughout the course that require student reflection with the support of a facilitator. These activities will focus on anatomical dissections and small group teaching, as well as instruction, discussion, and supervision of ACOS competencies.

III) Dissection Labs: Students will perform faculty-supervised, specialty-specific cadaveric dissections for which they will be expected to prepare and which they will present to the group at the end of each lab. Recall and application of this knowledge will be expected and evaluated at the end of each session.

IV) Independent Learning: It is expected that the student will complete independent learning modules as well as independent practice of surgical/interventional techniques in preparation for certification. In addition to independent practice, online module completion will be expected in the Identification of Tubes and Drains, FAST exam, Respiratory compromise and Ventilator management, Host Microbiome and the treatment of Sepsis, Anuria and Oliguria, Acute Mental Status Change, Hypotension and Hypertension, Chest Pain and Arrhythmias, Electrolytes and Glucose Management, Ischemic Extremity Management, Pain Assessment and Management, and Review of Surgical hemostasis.

V) Wet Labs: Planned activities using simulators, mannequins or live pigs will be used to allow students to practice invasive patient procedures. These include Wet Lab 1 – Surgical Emergencies I: Airway, Cricothyroidotomy, Open Tracheostomy, Percutaneous Tracheostomy, Thoracostomy Tubes; Wet Lab 2 -Fundamentals of Laparoscopic Surgery (FLS); Wet Lab 3 – Integument: Skin grafts, Burns, Complex Wound Care, Suturing, Knot tying, Wet Lab 4 – Surgical emergencies II: Control of Bleeding Vessels, Pericardial Tamponade, Doppler use/ABI; Wet Lab 5 – Vascular Access: Central line, Peripheral IV, arterial lines, IO IV; Wet Lab 6 – Principles of Robotic Surgery; Wet Lab 7 – Demonstration of Surgical Skills (pig lab)

SCHEDULE:

Students will complete 10 all-day anatomic dissection sessions on Tuesdays & Thursdays. Every Wednesday, there will be an all-day wet lab for the entire class. For eight Tuesdays and Thursdays there will be assigned surgical case presentations with the entire class for 1 or 2 hours at the end of the day. On days in which students are not in dissection lab they will be expected to complete their independent modules, independently practice competencies or participate in small group sessions. When the student believes they have acquired the necessary skills for competency, they can request evaluation for certification. The final week will be devoted to certification for any remaining skills as well as a final pig lab in which the student will serve as the operating surgeon (with guidance) for procedures such as a laparoscopic appendectomy, open splenectomy, operative treatment of life-threatening hemorrhage, tracheostomy and chest tube installation. Advanced Trauma Life Support (ATLS) certification will also occur in this final week.

ASSESSMENT: Student performance will be evaluated immediately after each dissection/case presentation via narrative assessment based on accuracy and care in anatomic dissection, ability to provide effective small group anatomy teaching, and quality of the surgical case presentation. It is expected that all students will complete training for all surgical competencies. Certification in these competencies will be awarded when the student performance meets certification requirements; evaluation of these activities will be either “certified” or “not-certified”. The Surgical component will comprise 60% of the final grade; the Anatomy/Case presentation, 40%.

ADMINISTRATIVE INFORMATION
Program Number: ELEC 515
Location: Cadaver Dissection Laboratory (703 CMWT), the Surgical Innovation Training Lab (SITL) & the Biological Resources Laboratory (BRL)
Program Co-Directors:
Surgery component – Amelia Bartholomew, MD, MPH, FACS &
Anatomy component – Norm Lieska, PhD
Email:[email protected], [email protected]
Coordinator: Tricia Harvat
Email: [email protected]
Duration: 6 Weeks
Lectures/Conferences/Faculty contact: 14 hrs/wk
Night Call: No
Laboratory: 19 hrs/wk
One Day: Advanced Trauma Life Support (ATLS) certification
Students accepted: Min. 6 Max. 12
Housestaff used as Faculty: Yes, Fellows in Robotic and Minimally Invasive Surgery.
Total hours/week: ~40

Update:  04/04/2022