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The Third Year Clerkship in Surgery Weill Cornell Medical College. New Resident Orientation 2007-2008. Orientation Session Objectives. Identify rationale for residents as teachers in clerkships Describe clerkship, including format and learning objectives

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The Third Year Clerkship in Surgery Weill Cornell Medical College

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The third year clerkship in surgery weill cornell medical college l.jpg

The Third Year Clerkship in SurgeryWeill Cornell Medical College

New Resident Orientation

2007-2008


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Orientation Session Objectives

  • Identify rationale for residents as teachers in clerkships

  • Describe clerkship, including format and learning objectives

  • Define students’ roles and responsibilities

  • Define residents’ roles and responsibilities


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Rationale for Residents as Teachers

  • Teaching is our professional responsibility

    • Professionalism

  • Teaching can aid our own learning

    • Practice-based learning

  • Residents have most contact with students

    • Increased opportunity to observe the students and to be observed by the students


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The Clerkship

Personnel:

  • Director – M. Michael Eisenberg, M.D.

  • Associate Director – Sandip Kapur, M.D.

  • Clerkship Coordinator – Krista Jenkins

  • Administrator – Kristi Volpp


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The Clerkship

Format:

  • 12 weeks

    • 8 weeks of rotation on General Surgery services

    • 4 weeks of elective rotations & Anesthesiology

  • Formal didactic teaching, tutorial sessions, house staff conferences, and core curriculum days at NYPH

  • Evaluation by Attendings, shelf exam, tutors and you!

    • Honors, High Pass, Pass, Fail


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The Clerkship

Requirements:

  • Patient log

  • Direct observations

  • Clinical evaluation


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The Clerkship

More Student Objectives:

  • Act professionally at all times

  • Participate in patient care as active team member

  • Demonstrate clinical reasoning skills

  • Demonstrate critical thinking skills

  • Demonstrate self-directed learning


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The Clerkship

Learning and Teaching Venues:

  • In the clinical setting

  • In conferences

  • In core lectures

  • In tutorial sessions


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The Clerkship

Where is the student?

  • With you

  • With the patient

  • In tutor group

  • In lecture


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The Student

  • Learner

  • Active team member

    • Active participation vs. scut

  • Liaison between patients and family and team


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The Student

Responsibilities as Team Member:

  • Attends all rounds and conferences with the team

  • Responsible for his/her “own” patients

    • Pre-rounds on own patients

    • Writes admission, daily, and off-service notes

      • Responsible to get resident co-sign or write an “agree with” note within 24 hours

    • Presents at rounds

      • Patient data and mini-lecture

    • Accompanies patient to consultations and procedures

  • Assists in care of all patients


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The Resident

Roles:

  • Teacher

  • Supervisor

  • Evaluator

  • Role model


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The Resident

As Teacher:

  • Set expectations for performance

  • Promotes self-directed learning

  • Teach at the bedside

    • Demonstrate

    • Observe

    • Provide feedback

  • Teach through the day

    • Think out loud

    • Include a Teachable Moment

    • Deliver and assign “mini-lectures”


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The Resident

As Supervisor:

  • Assign patients and tasks to promote student’s learning and to integrate them into team

  • Assure adequate supervision of students as they provide patient care, including performing procedures

  • Co-sign notes or write “agree with” notes within 24 hours

  • Co-sign orders


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The Resident

As Supervisor--Physical exams and procedures:

  • The student exam does not “count”, you must examine each patient yourself

  • Students must be chaperoned when performing pelvic exams

  • Students may perform procedures for which they have been certified with general supervision, other procedures must be performed with direct supervision

  • Students may not accompany monitored patients off the floor

  • Students may not administer any meds, immunizations, or IVF


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The Resident

As Supervisor--Notes and Orders:

  • Student notes contribute valuable information

  • Student notes can impact on medical-legal matters

  • Co-sign all student orders

    • Although students can write orders under your direction, these orders cannot be taken off without your co-signature


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The Resident

As Supervisor--Notes :

  • You must read the student note and write your own note

    • Your note should be able to stand alone

  • Every student note must be co-signed or have an “agree with (med student name)” note signed by the supervising resident within 24 hours

  • If you have a difference of opinion with a clinically significant part of the student note, explain this in your note in a neutral manner; e.g.:

    • “I agree with med student note, except that on my examination, murmur is not audible.”


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The Resident

As Evaluator:

  • Provide ongoing, timely feedback

  • Contribute to summative evaluation

    • Turn in your evaluation forms ASAP!!!

    • Most students “sometimes exceed expectations”

    • Comments on specific, observed behaviors are essential

      • Your comments contribute to the Dean’s letter

      • “A pleasure to work with” is not useful


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The Resident

As Role Model:

  • You are a walking, talking textbook

  • Hidden curriculum

    • That which is learned through role modeling, rather than explicit teaching, through acculturation and assimilation

      • Learning may be subconscious

    • Can be more powerful than the “explicit curriculum” of the classroom


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THANK YOU!


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