Department of Surgery

Department of Surgery Electives

NOTE:
Students applying for any Surgery elective will need to complete the Visiting Student Agreement* prior to acceptance. Please allow additional time to complete this paperwork. Email or phone notification of paperwork being sent will not be accepted. ALL paperwork MUST be received by our office NO LATER than six weeks prior to the start of the elective. Unfortunately, we can make no exceptions.

Submit the completed Visiting Student Agreement* to:
Nicole Stenstrom, Program Support Assistant, University of Hawaii. Surgery Department, 1356 Lusitana Street, 6th Floor, Honolulu, HI 96813.

1. General Surgery Sub-Internship
2. Pediatric Surgery Sub-Internship
3. Surgical Intensive Care
4. Surgical Specialty – Orthopaedics
5. Surgical Specialty – Plastic Surgery
6. Surgical Specialty – Anesthesia

1. GENERAL SURGERY SUB-INTERNSHIP:
Program Coordinator: Susan Steinemann, MD
Locations: General Surgery – Kuakini Medical Center, 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 his/her third year clerkship experience.

Method:
The student will be integrated into the surgical team at a position analogous to PGY-1 level (“Intern”). His/Her
service assignment and evaluation will be monitored by the coordinator for this sub- internship at the selected hospital. He/She will be assigned an appropriate number of hospital patients whom he/she will evaluate by a complete history and physical examination, and will initiate management by writing initial orders. He/She will perform those duties and procedures reasonably expected of the PGY-1 level resident. He/She will make rounds with the Staff according to established routine and will be expected to write progress notes at appropriate, timely intervals. He/She will 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. The student will observe or assist in all major and minor operations upon his/her patients as well as ward procedures. He/She will attend all clinical meetings and conferences that his/her team attends and will present at these meetings at the discretion of his/her Chief or Senior Resident or Surgical Preceptor. He/She will be 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.

2. PEDIATRIC SURGERY SUB-INTERNSHIP:
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 his/her introduction into the surgical fields on a plane of responsibility higher than that
of his/her third year experience.

Method:
The student will be integrated into the surgical team at a position analogous to L-1 level (Intern). His/Her assignment and evaluation will be monitored by the coordinator for this sub- internship at each hospital. He/She will be assigned an appropriate number of hospital patients whom he/she will evaluate by a complete history and physical examination, and will initiate management by writing initial orders. He/She will perform those procedures normally allotted to the L-1 level resident. He/She will make rounds with the staff per routine and will make progress notes
at appropriate intervals. He/She will attend patients as the initial physician as often as possible. The student will observe or assist at all major and minor operations upon his/her patients as well as ward procedures that are time convenient. He/She will attend all clinical meetings and conferences that his/her team attends and will present at these meetings at the discretion of his/her superiors. He/She will be assigned night call on a rotation basis
per routine.

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.

3. SURGICAL INTENSIVE CARE:
Program Coordinator: Mihae Yu, 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, the student 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 situations.

Method:
The student will be integrated into a Surgical Intensive Care Service team at a position analogous to L-1 level.
His/Her assignment and evaluation will be monitored by the ICU coordinators. He/She will perform those procedures normally allotted to the L-1 level resident (Intern). He/She will make rounds with the staff per routine and will make progress notes at appropriate intervals. He/She will obtain the 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, he/she 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 his/her evaluation and orders will be checked and countersigned by a L-2 or L-5 resident or staff physician. He/She will attend all meetings and conferences that his/her team attends and will present at these meetings at the discretion of his/her superiors. He/She will be assigned night call on a rotation basis per routine.

Evaluation:
He/She will be evaluated on a daily basis byhis/her immediate superiors and a subjective evaluation will be made concerning his/her performance at the completion of the clerkship.

4. SURGICAL SPECIALTY – ORTHOPAEDICS:
Program Coordinator: Robert E. Atkinson, 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 that the student was exposed to in his/her third year yet will still be give 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 of instruction will be managed much as a preceptorship. The student will be assigned to a member of the orthopaedics faculty and will pretty much mimic his/her daily routines. The students will see patients in the offices, work up pre-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 encouraged 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”). His/Her service assignment will be monitored by the Chief Orthopaedic Resident. He/She will be assigned an appropriate number of hospital patients whom s/he will evaluate. He/She will make rounds with the Staff and will be expected to write progress notes at appropriate, timely intervals. He/She will attend scheduled outpatient clinics and see new or emergency patients as often as possible. The student will observe or assist in all major and minor operations as well as ward procedures. He/She will attend all scheduled clinical meetings and conferences that his/her team attends. He/She will be 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 end of the clerkship by the preceptor
and/or supervising resident.

5. SURGICAL SPECIALTY – PLASTIC SURGERY:
Program Coordinator: F. Don Parsa, MD

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

  1. Know how to suture wounds in a professional manner independently.
  2. Know how to place simple and more complex stitches: simple interrupted skin sutures, interrupted intradermal sutures and running intradermal sutures.
  3. Know the indications for use of different suture materials
  4. Understand how to perform suturing in a most efficient manner.
  5. Know how to handle tissues during surgery and minor surgical procedures with least trauma.
  6. Know how to obtain hemostasis with least damage to surrounding tissues.
  7. Know the no-touch techniques when inserting foreign devices into patients.
  8. Know how to perform procedures as an outpatient under local anesthesia.
  9. Know the indications for intravenous sedation an dhow to perform procedures under light sedation.
  10. Know how to diagnose common skin tumors such as BCC, Squamous cell carcinoma and Melanoma.
  11. Know the classification of Melanomas.
  12. Know how to diagnose and treat hand’s nerve and tendon injuries.
  13. Know how to diagnose and treat various facial fractures.
  14. Know the principles of breast reconstruction after mastectomy.
  15. Know the principles and indications of various aesthetic surgical procedures.
  16. Know how to manage minor burns and wounds as an outpatient.
  17. Learn the techniques of microsurgery under microscope if interested.

Method:
Students will spend the majority of their 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 his/her 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 student’s performance will be submitted at the end of the clerkship by the preceptor and/or supervising resident.

6. SURGICAL SPECIALTY – ANESTHESIA
Program Coordinator: Jason Isa, MD

Objectives:
The student will be able to recognize and describe basic aspects of general and regional anesthesia. He/she shall be able to demonstrate basic skills such as bag-mask controlled respiration, insertion of airways, application of monitoring aids, and will be able to calculate various drugs and fluid dosages.

Method:
The student will 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. He/she will 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 clinical science knowledge and professionalism in a narrative summary. Grades are assigned as “Credit/No Credit”.

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