Surgery & Anaesthesia :: Undergraduate Teaching
4th Year
Resuscitation Module
The major objectives of this module are for students to :
Understand the New Zealand Resuscitation Council Guidelines for
the Medical provider for adult collapse, childhood collapse, trauma
and other life threatening conditions
Develop practical resuscitation skills
Understand the pathophysiology of life threatening conditions
Use anaesthesia as a model for the understanding of clinical pharmacology
and physiology
Further information is available in the 4th and 5th Year Student
Handbook
5th Year
Skin and Muskuloskeletal Medicine Module
The locomotor and dermatology module covers orthopaedics, rheumatology,
plastic surgery and dermatology.
Aims and Objectives
By the end of the module the student will be able to:
- Recognise variations from the normal in a patient presenting
after injury, or with musculoskeletal or dermatological symptoms.
- Apply the principles of management of the common musculoskeletal
and dermatological disorders.
- Describe the part played by the different health-care disciplines
in the management of musculoskeletal and dermatological disorders
and disabilities and to know how and when this help should be
obtained.
- Manage the general problems of the injured patient or the patient
with musculoskeletal or dermatological disorders in hospital,
at the level appropriate to a house surgeon, with supervision.
- Adapt the above behaviour in changing circumstances in the best
interests of the patients and their social circumstances.
- Adopt an informed, critical attitude to the delivery of care
for musculoskeletal and dermatological disorders.
Further information is available in the 4th and 5th Year Student
Handbook
6th Year
TI Objectives
Surgery One (General Surgery)
By the end of the 4 week attachment ALL Trainee Interns will be
able to do the following -
Elective Patients (i.e. those seen in outpatients)
- take a focused history of the system of interest
- undertake an appropriate examination
- formulate a differential diagnosis and initial plan of management
- present the above to the Senior Surgical Registrar or Consultant
- dictate an appropriate clinic letter (if approved by your consultant)
Acute Admissions - Trainee Interns are required to participate
in at least 3 nights on-call with the team, they will
- take histories and examine patients
- formulate differential diagnoses
- initiate appropriate initial management plans / investigations
(after discussion with the Registrar and under the supervision of
the Registrar or House Surgeon)
- attend and assist at any surgery for those patients you have admitted
- take responsibility for ongoing ward management for at least 2
patients after each on-call period (to be done with aid of registrars
/ house surgeons)
Ward Management - apart from the patients taken responsibility
for as described above the Trainee Intern will manage the ward alongside
the House Surgeon and must
- know how to prescribe appropriate simple oral and intramuscular
pain relief (not PCA / epidural).
- understand the principles of maintenance and replacement fluid
therapy.
- know how to chart IV fluids and correctly interpret a fluid balance
chart.
- understand the principles of investigation and management of common
post-op complications including cardio-respiratory complications
(chest pain, arrhythmia, infection, PE), pyrexia, hypotension, low
urine output, urinary retention, confusion and DVT.
- know the advantages / disadvantages, complications and indications
for blood transfusion
- Understand the principles of total nutritional support (enteral
and parenteral).
The following is a list of common general surgical conditions.
A Trainee Intern should know how they commonly present, how to examine
for them and how to investigate and manage them. Any condition that
has an asterisk is considered an essential knowledge requirement
and it is expected that the Trainee Intern will have encountered
this condition during the attachment.
- Appendicitis * - Pancreatitis
- Diverticulitis * - Cholelithiasis / cholecystitis *
- Inguinal Hernia * - Incisional / Femoral hernia
- Large Bowel Obstruction - Small Bowel Obstruction
- Volvulus - Pseudo-obstruction
- Colorectal Cancer * - Lumps - neck, thyroid, groin and scrotum
- Anal Problems - fissure, fistula, haemorrhoids*, cancer, pruritis,
- Abscesses* - especially perianal, ischiorectal and breast
- Ischaemic gut - Pilonidal sinus / abscess*
Surgery Two
Each sub-speciality will have specific educational objectives.
The Trainee Intern must discuss these with the appropriate consultants
at the start of the attachment. At the end of 4 weeks the Trainee
Intern should be able to outline and manage the pre-operative and
post-operative requirements for patients of the sub-speciality to
which they are attached.
TI Assessment
Trainee Intern Assessment in Surgery and Anaesthesia
Trainee interns are allocated to two four week rotations in Surgery.
During the course of these rotations students will be assessed using
a series of assessment tools. These tools attempt to provide both
summative and ongoing formative multidimensional assessment and
to allow students to take remedial action as to any identified deficiencies
before any decision is made with regard to end of year pass / fail
examination.
Trainee Interns will be assessed using four assessment tools.
… Skills Log Book
… Consultant and Registrar Rotational Assessments
… Short Answer theory examination
… One Case Report
Each of these four assessments will be marked according to four
assessment categories:
… Fail
… Conditional pass
… Pass
… Potential distinction
For the case report marking the "pass" grade will be
marked as "pass" or "good pass" to note performance
that was considered of quality, but below that required for distinction
grading.
A pass in the four assessment tools is required for successful
completion of the surgical attachment.
All assessments will be reviewed by the TI Co-ordination Committee
at the beginning of the fourth week of the second surgical attachment.
Those students attaining any "unsatisfactory" assessment,
or two or more "borderline" assessments will be informed
that they will be required to sit an oral examination at the end
of the final week of their second surgical attachment. On the basis
of this oral examination and the other assessments, students may
be required to sit the end of year pass/fail examination. This selection
for pass/fail will be conveyed to students the week following the
second surgical attachment. This mechanism may allow students to
remedy unsatisfactory knowledge deficits during the final week of
the second surgical attachment, and in the case of unsatisfactory
performance in the end of run oral examination, provide forewarning
of the end of year pass/fail examination.
Specific Assessment Tools
Skills Log
The student must demonstrate a satisfactory performance of, or
attendance at, a range of surgical skills. Students are required
to have the listed skills signed off from their Skills Log as satisfactory
by a member of the surgical team. The Log book or a photocopy of
the log book must be returned to the TI Surgical Co-ordination Group
secretary (Ms J Meaclem) one week prior to completion of the second
surgical rotation. If the surgical rotation finishes on a Friday,
then the Log book must be returned by the Monday of week 4 by 9am.
Performance will be based upon the number of skills completed
Consultant and Registrar Rotational Assessments
Each student will receive two assessment forms for each surgical
/ anaesthesia rotation. For each rotation, one must be completed
by a registrar, and the other by the consultant supervisor. The
registrar and consultant should be those that have had sufficient
student contact with which to base their assessment. Plainly therefore
students should make themselves known by attendance and interest
in the attachment. The inability of a consultant or registrar to
make assessments because of unfamiliarity is not regarded as satisfactory.
These forms must be completed during the third week of each
rotation. These forms are for completion in the presence of the
student in order that any perceived deficiencies that are identified
can be discussed. These assessment forms must be returned by
the student to the Department of Surgery by 9am on
the Monday of the fourth week of each rotation.
Short Answer Question Examination
At the end of the third week of the second rotation students will
sit a 1.5 hour short-answer examination. Each of 150 questions will
be of a true / false nature and a pass mark of 75% will be required
to attain satisfactory assessment. Grade allocation will be:
… Potential Distinction 90%
… Pass 75%
… Conditional pass 70%
… Fail < 70%
All questions will be taken either from:
… Any section of the recommended text "Oxford Handbook
of Clinical Surgery" or
… Tutorial material given during the surgical rotations.
Case report
Students are required to submit one case report at the completion
of their first surgical attachment. A template and guideline for
the completion of this case report is provided. The case report
must be returned by the student to the Department of Surgery by
4pm on the last day of the first rotation.
Unsatisfactory completion of the case report, or late return of
the case report will automatically require the student to submit
a second case report by the end of the third week of the second
surgical rotation.
Assessment Deadlines
First Rotation
9am, Monday of week four
… First rotation consultant and registrar assessment forms
must be returned to the department of surgery.
4pm, last day of week four
… Case Report must be returned to the Department of surgery.
Second Rotation
Last day of week three.
… Short answer examination for all students.
9am, Monday of week four.
… Second rotation consultant and registrar assessment forms
must be returned to the department of surgery.
… Second Case report must be returned for those students providing
an unsatisfactory first case report.
… Skills Log book
Last day of week four
… Oral examination for unsatisfactory students and subsequent
consideration for end of year pass/fail examination.
Late Return of Assessment Material
… An "in-tray" is provided in the department of
surgery foyer for students to return all relevant material. Assessments
should be in sealed envelopes, marked "Jo Meaclem, TI coordination
secretary".
… Students must plan to complete assessments by the specified
date.
… Late return of any material will automatically mean
that the highest possible assessment for that material will be "pass".
… The TI coordination committee meet to discuss assessments
on Monday of the last week of the second surgical attachment. In
order for students to know as soon as possible, whether an end of
run oral examination is required, it is very important that all
relevant material is available for that meeting. Delay in return
of material may mean that the student will only learn of this on
the day prior to the oral examination.
… If material remains outstanding by 5pm on the Wednesday
of the final week of the second rotation, the student will automatically
be required to sit an end-of-run oral examination.
… If any material remains outstanding after the second
rotation, the student will be required to attend an end of year
pass/fail examination.
… For a case report, late return during the first rotation
will require that a second case report must be completed
in the second surgical rotation. The highest possible assessment
for that second case report will be "satisfactory".
… In exceptional circumstances (such as bereavement) late
return of assessments will naturally be accepted without penalty.
However it should be stressed that these will be exceptional
circumstances only, Students should therefore prepare in advance
and not plan to submit material at the last moment.
Distinction
Any student attaining a "potential distinction" mark
in their written theory examination and one other potential
distinction assessment and no "fail" assessment,
will be offered a distinction examination at the end of year.
Surgical TI PASAF
The PASAF provides a standardised summary of student performance
at the end of the trainee intern year.
The PASAF comprises grading on:
… Overall achievement
… Summary of all formal summative assessments
… Collective opinion on professional attitudes.
Grades are allocated as:
… Fail
… Conditional pass
… Pass
… Potential distinction
The surgical assessment tools contribute to these grades as follows:
Overall achievement
… All assessments
Summary of all formal summative assessment;
… Short answer examination
… Case Report
… Surgical Skills Log
… End of run oral examination for unsatisfactory students
… End of year pass/fail oral examination
Collective opinion on professional attitudes
… Consultant and registrar assessments
… Where relevant, TI Coordination Committee opinion
It will be recommended to the University that any trainee intern
attaining a "fail" in any of these three PASAF attributes
will repeat one surgical rotation, during which the student will
be required to complete all assessments considered unsatisfactory
during their two previous rotations.
Assoc Prof Duncan Galletly
Convenor
TI Surgical Coordination Committee
Case.pdf
Feedback.pdf
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