Surgery Electives

Program Coordinator: Susan Steinemann, MD
Location: Queen’s Medical Center

Objectives:

• This clerkship consists of a 4-week experience on a busy Surgical Service in one of the participating hospitals.
• The major objective is to provide the student with additional experience in the surgical disciplines concomitant with graded responsibility (commensurate with level of competency) beyond that of their third year clerkship experience.

Method:

• Students will be integrated into the surgical team at a position analogous to PGY-1 level (“Intern”). Their service assignment and evaluation will be monitored by the coordinator for this sub-internship at the selected hospital.
• Students will be assigned an appropriate number of hospital patients whom they will evaluate by a complete history and physical examination, and initiate management by writing initial orders. The student will perform those duties and procedures reasonably expected of the PGY-1 level resident.
• Make rounds with the Staff according to established routine and will be expected to write progress notes at appropriate, timely intervals.
• Attend scheduled outpatient clinics and will see new or emergency patients as the initial physician as often as possible, as designated by the Chief or Senior Resident of the Service as deemed appropriate.
• Observe or assist in all major and minor operations upon their patients as well as ward procedures
• Attend all clinical meetings and conferences that their team attends and will present at these meetings at the discretion of their Chief or Senior Resident or Surgical Preceptor.
• Expected to take in-house night call on a rotation basis, as would be reasonable and appropriate and expected for a PGY-1 level resident.
• The level of graded responsibility delegated to each student will progressively increase during the course of the rotation, in accordance with degree of proven competency, based on assessment by the supervising Resident and Preceptor.

Evaluation:  Students will be evaluated on a daily basis by immediate superiors and a subjective evaluation will be made concerning their performance at the completion of the clerkship.

Program Coordinator: Walton Shim, MD
Location: Kapiolani Medical Center for Women & Children

Objectives:  This clerkship will consist of a four-week experience on a busy surgical service. The major objective is to allow the student to further their introduction into the surgical fields on a plane of responsibility higher than that of their third year experience.

Method:

• The student will be integrated into the surgical team at a position analogous to L-1 level (Intern). Their assignment and evaluation will be monitored by the coordinator for this sub-internship at each hospital.
• Assigned an appropriate number of hospital patients whom they will evaluate by a complete history and physical examination, and will initiate management by writing initial orders. They will preform those procedures normally allotted to the L-1 level resident.
• Make rounds with the staff per routine and will make progress notes at appropriate intervals.
• Attend to patients as the initial physician as often as possible.
• Observe or assist at all major and minor operations upon their patients as well as ward procedures that are time convenient.
• Attend all clinical meetings and conferences that their team attends and will present at these meetings at the discretion of their superiors.
• Night call will be assigned on a rotation basis per routine.

Evaluation:  Students will be evaluated on a daily basis by immediate superiors and a subject evaluation will be made concerning their performance at the completion of the clerkship.

Program Coordinator: David Inouye, MD
Location: Queen’s Medical Center

Objectives:

• This clerkship will consist of a four-week experience as a member of the Surgical Intensive Care Service, providing cardiopulmonary care and life support to pre- and post-operative patients.
• Under supervision, students will learn hemodynamic monitoring, pulmonary pathophysiology and ventilator management, renal dysfunction, nutritional support, and treatment of all types of shock: septic, hemorrhagic, neurogenic and myocardial shock.
• The goal of this rotation is to transform a 4th year medical student into a functional resident able to handle life threatening situation.

Method:

• The student will be integrated into a Surgical Intensive Care Service team at a position analogous to L-1 level.
  
  • Their assignment and evaluation will be monitored by the ICU coordinators.
  • The student will perform those procedures normally allotted to the L-1 level resident (Intern).
• Make rounds with the staff per routine and make progress notes at appropriate intervals.
• Obtain physiologic measurements required for evaluation of hemodynamic, pulmonary and renal function and use the minicomputer to analyze the data.
• Using clinical information and monitoring parameters, the student will assess life-support requirements including ventilator support, pharmacologic manipulation of cardiovascular function and parenteral nutrition and initiate appropriate therapy after senior team-member concurrence.
• All phases of students evaluation and orders will be checked and countersigned by a L-2 or L-5 resident or staff physician.
• Attend all meetings and conferences that their team attends and will present at these meetings at the discretion of their superiors.
• Students will be assigned night call on a rotation basis per routine.

Evaluation:  Students will be evaluated on a daily basis by their immediate superiors and a subjective evaluation will be made concerning their performance at the completion of the clerkship.

Program Coordinator: Kyle Mitsunaga, MD

Objectives:

• This block of instruction is designed to give the student an added exposure to the field of orthopaedics.
• This will be an experience on a broader and more involved plane than what the student was exposed to in their third year yet will still be with the premise that the student is seeking knowledge in this field in order to perform more effectively as a “generalist” and is not necessarily interested in orthopaedics as a career.

Method:

• This block will of instruction will be manages much as a preceptorship.
• Students will be assigned to a member of the orthopaedics faculty and will pretty much mimic their daily routines.
• See patients in the offices, work up per-operative patients, attend the surgical procedures, make daily rounds and write appropriate progress notes.
• There will be no night or weekend call schedule.
• Students interested in Orthopaedics as a career are encourages to spend 2 of their 4 weeks on the Orthopaedic Surgery Service at the Queen’s Medical Center.
• The student will be integrated into the Orthopaedic team at a position analogous to PGY-1 level (“Intern”). Students service assignment will be monitored by the Chief Orthopaedic Resident.
• Students will be assigned an appropriate number of hospital patients whom they will evaluate.
• Will make rounds with the Staff and be expected to write progress notes at appropriate, timely intervals.
• Attend scheduled outpatient clinics and see new or emergency patients as often as possible.
• Observe or assist in all major and minor operations as well as ward procedures.
• Attend all scheduled clinical meetings and conferences that their team attends.
• Expected to take in-house night call.
• The level of graded responsibility delegated to each student will progressively increase during the course of the rotation, in accordance with degree of proven competency, based on assessment by the supervising resident and preceptor.

Evaluation:  A final summary of the student’s performance will be submitted at the ends of the clerkship by the preceptor and/or supervising resident.

Program Coordinator: F. Don Parsa, MD

Objectives:  The students should accomplish the following at the end of their rotation:

• Suture wounds in a professional manner independently.
• Understand how to place simple and more complex stitches: simple interrupted skin sutures, interrupted intradermal sutures and running intradermal sutures.
• Know the indications for use of different suture materials.
• Perform suturing in a most efficient manner.
• Handle tissues during surgery and minor surgical procedures with least trauma.
• Obtain hemostasis with least trauma.
• Know the no-touch techniques when inserting foreign devises into patients.
• Preform procedures as an outpatient under local anesthesia.
• Know the indications for intravenous sedation and how to perform procedures under light sedation.
• Diagnose common skin tumors such as BCC, Squamous cell carcinoma and Melanoma.
• Know the classification of Melanomas.
• Diagnose and treat hand’s nerve and tendon injuries.
• Diagnose and treat various facial fractures.
• Understand the principles of breast reconstruction after mastectomy.
• Understand the principles and indications of various aesthetic surgical procedures.
• Manage minor burns and wounds as an outpatient.
• Learn the techniques of microsurgery under microscope if interested.

Method:

• Students will spend the majority of the time at the Queen’s Medical Center Scrubbing with Plastic Surgery Faculty.
• Principles of surgery and tissue handling as well as suturing techniques are taught during this time.
• In the absence of surgery residents, the medical student assists in the operating room and performs various tasks commensurate with their level of experience and training.
• Some of the patients who are of a learning value are seen and examined and followed at the hospital.
• If there is no operating room activity at the Queen’s Medical Center, Dr. Parsa may recommend the students to shadow other attendings at other hospitals and facilities other than Queen’s.
• Students do not take any calls but they may scrub on cases during the weekends and after hours.
• Only if there are no cases scheduled at the Queen’s Medical Center, students are invited to scrub on cases performed at the private offices.

Evaluation:  A final summary of the student’s performance will be submitted at the end of the clerkship by the preceptor and/or supervising resident.

Program Coordinator: Jason Isa, MD

Objectives:

• Will be able to recognize and describe basic aspects of general and regional anesthesia.
• Shall be able to demonstrate basic skills such as bag-mask controlled respiration, insertion of airways, application of monitoring aids, and be able to calculate various drugs and fluid dosages.

Method:

• Engage in direct practical experiences such as pre-op rounds, the induction, maintenance and emergence of anesthesia and the post-operative care of the patient under the direct supervision of a board certified anesthesiologist.
• Question and compare the anesthetic approaches of different staff anesthesiologists.
• Specialty experiences will be available if the students desire such experiences, e.g., obstetric anesthesia, cardiovascular anesthesia.
• There will be no night or weekend call.

Evaluation:  Students will be evaluated by their preceptor(s) based upon basic and clinical science knowledge and professionalism in a narrative summary. Grades are assigned as “Credit/No Credit”.