The following is an outline of a typical day for students during their clerkship:
|5 A.M. - 6 A.M.||Pre-Rounds|
|6 A.M. - 8 A.M.||Rounds w/Chief Resident|
|8 A.M. - 5 P.M.||Operating Room
|5 P.M. - 6 P.M.||Afternoon Rounds|
|6 P.M. - 10 P.M.||Late Call|
|6 A.M.||Catch Shuttle 99th/Madison|
|6:30 A.M. - 7 A.M.||Pre-Rounds|
|7 A.M. - 8 A.M.||Rounds w/Chief Resident|
|8 A.M. - 5 P.M.||Operating Room
|5 P.M. - 6 P.M.||Afternoon Rounds|
|6 P.M. - 7 A.M.||Overnight Call|
On Weekends and Holidays, students are expected to come in if on call.
Students are active members of the surgical team and directly participate in patients' care, with responsibility for between two and five patients at all times, usually a person the student has operated on, seen in the ER, or consulted on. Students are expected to know "everything" about their patients, in even greater detail than the residents.
Students are involved with their patients scheduled dressing changes, and assist on any bedside procedures (e.g., insertion of nasogastric tubes, blood draws, drain maintenance). They follow patients closely, and can even accompany them during procedures and studies (e.g., interventional studies, CT scans, central lines). Students are encouraged to personally review their patients' radiologic studies and pathology results with physicians of those departments.
These bedside rounds are conducted by the Chief Resident every morning, and are an opportunity for students to impress their team with their presentation skills and knowledge of their patients. Students are expected to pre-round on their patients and have notes prepared before rounds start. Students must be on time for morning rounds.
A perfect presentation is complete but succinct. Students do not have to present everything, but are expected to know everything when asked. Presentations should also follow the format of a daily progress note (Word Document). Be sure to have your progress notes cosigned/amended by your team's interns/residents.
Rounds are an opportunity for students to demonstrate their team playing capabilities. Students should proactively assist their team with procedures, dressing changes, other tasks during rounds. Designating one person to carry around a “dressing box” (of bandages, tape, etc…) is a good idea. The most successful students are respectful of their classmates and residents, always bearing in mind that rounds is a learning environment in addition to a working environment. Students should not interrupt others during their presentations, and should expect to be asked questions regarding their cases. It is critical for students to pay attention to others' presentations; students can learn from others' cases just as much as their own.
These rounds are usually less formal than morning rounds and are conducted in the team rooms. Students are expected to attend PM rounds every day, unless they are given explicit permission to be absent.
At PM rounds, the daily labs are reviewed. Students are expected to follow up on their patients in the afternoon and present their course.
Two times a week during their rotation at Elmhurst , afternoon rounds will be conducted at the bedside with the attending physicians. Students present a brief HPI of their patients and their hospital course. This is an outstanding opportunity to shine in front of the Attendings.
Participating in Surgery
Students are allowed to choose the operative cases they want to participate in. It is best to aim for a broad range of experiences. The next day's OR schedule is usually available by 2-3 P.M. Your team's residents can show you how to access the electronic OR schedule. It is critical that students read about the next day's upcoming cases the previous night. The student's knowledge of their patients and their surgical disorders will be assessed in the operating room frequently.
Students should meet their patients in the Surgical Holding area 15 minutes before a case is to start. Ideally, students should be in the OR with their patients before the Residents or Attending physicians. This time is an opportunity to perform procedures such as IVs, and foley catheterizations. Once the operation starts, students assist on operations – retracting, holding the laparoscopic camera, and cutting sutures.
As they gain experience and skill, students are allowed to do more, such as suturing and knot tying. However, students should understand that they cannot expect to “practice” these skills on patients. Rather, suturing and knot tying should be perfected at home before being attempted in the OR. Students should not grab or touch instruments unless given permission, and should take care to pick appropriate moments to ask questions (there are good vs. bad times). After the case is finished, students are expected to stay with their patients until they are safely transported to the recovery room. Students then assist the residents with the operative note and postoperative orders.
Clinics and ER
The outpatient clinics and ER are great opportunities for students to initially evaluate patients for surgical problems. Students may see patients on their own, or they may be accompanied by a resident or attending. This is a time for students to practice their focused evaluation and presentation skills.
Students attend all their team's outpatient clinics. The clinic and ER experience is much more extensive at Elmhurst, while the operative experience is more emphasized at Mount Sinai.
Students are expected to be on call approximately every fourth night according to when their “team” is on call. The chief resident works with the students in his charge to make the schedule. All call nights must be covered by a student, even the weekends and holidays between rotation changes. (e.g., the transition weekend between Elmhurst and Mount Sinai must be covered by the preceding students). Call schedules are posted in the team rooms.
When on call, students should work with the senior residents in evaluating consults whenever possible. Following the resident around is the easiest way to do this. When the action slows, students should use such times to "pick the resident's brain" for surgery topics, to practicing suturing, etc. In general, students should not wait to be paged when a consult comes up, as seeing how patients initially present in the ER is invaluable experience. Students should take the initiative to take their own History and Physical and try to formulate a diagnosis and plan themselves. Assisting interns with floorwork should be secondary. Students will participate on any late/urgent cases.
At Elmhurst, students carry a "student pager", participate in traumas, and evaluate ER and ward consults. The call night is excellent experience due to the broad range of surgical encounters at this site, and is usually quite busy. Students are permitted to go home post-call, after morning rounds.
At Mount Sinai, the call nights are less busy for students. Students may participate in late cases and evaluate consults. Students are usually excused by 10pm, but should keep themselves available to be called in for any interesting cases. Students are generally expected to come in for a full day the following day. That said, exceptions are made for students who are up all night helping out, who are permitted to go home post-call. Overnight call rooms are available, if needed.
Students are required to attend every weekday. On weekends, students are expected to come in if on call. On average, students have one day off a week. Students must inform their chief resident of any absences as soon as possible. Students are responsible to find a replacement if they are unable to take call overnight.
Appropriate conservative dress, with white coats is required. Shirts and ties are suggested for men. Hospital scrubs should not be worn outside of the hospital.