Surgery

The third-year clerkship in surgery is designed to provide our medical students with broad exposure to the wide variety of topics in both general surgery and the surgical subspecialties. Students may be assigned to a variety of rotations including General Surgery, Acute care surgery, Trauma surgery, Cardiothoracic surgery, Pediatric Surgery, Vascular surgery, or community based general surgical practice. Students completing the clerkship will be able to recognize common surgical diseases and be familiar with the initial evaluation and management of these common surgical problems.

This educational experience is provided through a combination of didactic teaching sessions, experience on the surgical ward, web-based learning, a regular conference schedule, suture skills lab (photos) (PDF), operative experience and interactive small group sessions. The student will develop an understanding of a wide variety of topics; this will provide the foundation for recognizing and treating patients in the years following their medical school education.

Andrew Kastenmeier, MD
Department of Surgery
Student Clerkship Director

Clerkship Program
The Junior Medical Student Surgery rotation consists of a 2-month clerkship. Each student will rotate on two separate services, one month on a general surgery rotation and the other month a surgical subspecialty rotation.

During the 2-month rotation, the student will be exposed to a broad range of patients with surgical problems and the student will function as an integral member of the surgical team, being included in many elements of the patient’s care. Students will participate in the preoperative, operative and postoperative care of the surgical patient. Students will be responsible for developing an understanding of surgical disease(s), the pathophysiology of the patient’s disease process, and gain knowledge of the decision-making and clinical judgment required in the care of the patient.

Each rotation site has weekly conferences, lectures and rounds in which students will fully participate.

Medical Student Performance Evaluation
Students are evaluated on clinical performance, oral presentation skills, lecture attendance, individual learning plans, and the NBME surgery subject exam. The NBME exam is administered at the end of the 2-month rotation. The clinical evaluation process and oral presentation occur throughout the clerkship.

Administrative
The Clerkship Director is Dr. Andrew Kastenmeier, Associate Professor in General Surgery. Dr. Kastenmeier is a member of the Student Education Committee.

The Surgery Student Coordinator, Catie Fihn, MBA, is a member of the Association for Surgical Education (ASE) and the Student Education Committee.

It is a firm belief that by the fourth year of medical school, students have acquired the necessary skills to function more independently, with a level of autonomy more closely resembling that afforded to a resident intern. The senior student is privileged with the opportunity to provide first encounter management, so as to formulate plans and therapies. Such opportunities enhance confidence-building as students mature to residency and ultimately to staff physicians. The independence afforded to fourth year students still requires staff intervention and physician oversight, in order to maintain continuous education for the student and optimal care for the patient.

Andrew Kastenmeier, MD
Department of Surgery
Sub-Internship Director

Sub-Internship Program
The fourth-year Surgery Sub-Internship program consists of a one-month rotation that serves as the foundation for students wishing to enter into a surgical residency. The purpose of this rotation is to familiarize the student with the responsibilities of a surgical resident and aid in the transition from medical student to resident physician.

Surgically oriented Sub-Intern rotations are offered in a number of specialties, including Vascular Surgery, Cardiothoracic Surgery, and General Surgery, amongst others. The Sub-Intern program is based on the M4 Surgical Sub-Internship Major Goals and Key Features, which were designed to preview the responsibilities of an intern during the fourth year.

During the one-month rotation, the Sub-Intern will be the source of first encounters with patients, performing a complete history, physical examination, differential diagnosis, diagnostic plan, and implementation of treatment. The clinical care provided by a Sub-Intern is always under resident or faculty supervision.

Medical Student Performance Evaluation
Each rotation has individualized their methods of evaluating the Sub-Interns. Oral presentations are required for all Sub-Internship rotations; some rotations may implement a written exam. All rotations will use standardized clinical performance assessment forms, completed by residents and attending faculty.

Administrative
The Director of the Sub-Internship Program is Dr. Andrew Kastenmeier, Associate Professor, General Surgery. Dr. Kastenmeier is a member of the Student Education Committee. The Surgery Student Coordinator, Catie Fihn, MBA, is a member of the Association for Surgical Education (ASE) and the Student Education Committee.

The surgical sub-internship, regardless of which department/division offers it, is designed to preview the responsibilities of an intern during the M4 year. Each student is required to complete a 1-month surgical sub-internship chosen from the list of CEC-approved rotations. These rotations may include any of the surgical specialties (including Obstetrics & Gynecology, anesthesiology and/or emergency medicine). Listed below are major goals for the sub-I and key features that constituent a Sub-Internship Experience.

Direct attending physician supervision is encouraged and preferable required as per LCME guidelines. All of the goals and key features will be accomplished with the appropriate supervision by senior residents and attending physicians.

Goals of Sub-Internship

1. Independently complete an initial assessment of the patient and his/her problems (e.g., to distinguish the patient who needs intervention now from the "sick" patient with less acute needs).
2. Manage the short-term needs of the acutely sick patient.
3. Formulate a diagnosis and a plan of treatment
4. After appropriate supervision, implement therapy based on assessment of risks/benefits of available therapies and monitor outcomes for the patients

Key Features of the Sub-Internship

1. Serve as the physician of first contact for assigned patients.
2. Be the physician of first contact for patients presenting with a diversity of multi-system problems and varying levels of problem severity and chronicity.
3. Have primary/initial responsibility for formulating:
   3.1 an H & P with differential diagnosis
   3.2 treatment plan
   3.3 monitoring effectiveness of treatment plan
   3.4 talking with patient about his/her condition 
   3.5 talking with family about patient's condition 
   3.6 daily follow-up (where applicable) 
   3.7 progress, discharge, planning notes
4. Experience the level of responsibility/autonomy similar to that of an early-year intern

Communication

1. Primary responsibility for communication about patients to:
   1.1 team
   1.2 patient and family
   1.3 other health care professional

Call (if applicable)

1. Assume call at a frequency appropriate for the service but no more often than every 3rd night.
2. Admitting new patients
3. Provide cross coverage appropriate to service
4. Supervision of "on call" experience provided by Attending or Senior Resident.

Conferences/Seminars

1. Attendance expected except when it interferes with urgent patient care responsibilities (patient care takes precedence)

Students can participate in various activities in the Department of Surgery, from their M1 year through M4 year. Several of these activities are highlighted as follows:

M1/M2

• Shadow a physician for a day in the operating room and/or clinics
• Take overnight call with the residents
• Meet with faculty to discuss potential research project opportunities
• Attend the annual “Meet the Surgeons” Social Hour held each fall
• Join the Student Surgical Society for more opportunities
• Apply for a travel grant to the American College of Surgeons Meeting
• Tour the operating room and learning scrubbing/gowning/gloving
• Participate in summer research projects with faculty mentors

M3

• Rotate with faculty and residents during the surgical clerkship
• Meet with the Residency Program Director and Chair to discuss surgical career options and the interview process
• Apply for a travel grant to the American College of Surgeons Meeting
• Participate in an O.R. training and sharps safety course
• Humanities (photos) (PDF)
• Enjoy lunches with the Residency Program Director and Chief of Division of Education
• Continue research or Pathway projects with faculty mentors

M4

• Rotate with faculty and residents during various sub-internship, elective and integrated selective rotations
• Apply for a travel grant to the American College of Surgeons Meeting
• Meet with Residency Program Director and Chair for further mentoring on the residency selection process

The Department of Surgery offers several clinical electives for visiting M4 medical students in several surgical disciplines: Trauma Surgery, Surgical Intensive Care, Pediatric Surgery, Surgical Oncology, Colorectal Surgery, and Minimally Invasive General Surgery. The Medical College of Wisconsin’s Office of the Registrar can assist students with the application process for these electives as well as provide information on local housing options. For more information, please visit the Visiting Student website.