MDC7600
MS3 SURGERY CLERKSHIP

MS3 SURGERY CLERKSHIP SYLLABUS
2025-2026
Department of Surgery
University of Florida College of Medicine
Duration: 8 weeks
Clerkship web page: https://ufl.instructure.com/courses/506623

CLERKSHIP INFORMATION

Clerkship Description
This is an 8-week clinical experience with two 3-week complementary core rotations on general surgery, one 2-week subspecialty rotation, and two overnight calls on trauma. You will be an active member of a busy surgical team. You will learn the general principles of surgery by participating in the care of patients in the operating room, on the ward, and in the clinic. In addition to your clinical experience, you will have a series of labs and small group sessions covering the general principles of surgery. We look forward to having you in surgery and will do everything possible to make your clerkship a rewarding experience! Learning surgery and its practice is fun – and we aim to achieve that for you.

Clerkship Committee:
Christiana Shaw, MD – Clerkship Director 352-278-4432, Email
Benjamin Jacobs, MD – Associate Clerkship Director, Email
Jennifer Fieber, MD – Surgery Interest Group Leader, Email
Crystal Johnson-Mann – Fourth Year Clerkship Director, Email
James Dennis, MD – Clerkship Director, Jacksonville, Email
Aditi Jalla, MD – Assistant Clerkship Director, Jacksonville, Email
Gilbert Upchurch, MD – Chairman, Department of Surgery
George Sarosi, MD – Vice-Chair of Surgery Education
Tyler Loftus, MD – General Surgery Program Director
Amalia Cochran, MD – Associate Program Director
Janice Taylor, MD – Associate Program Director

Coordinator:
Michelle DiGiacomo – Clerkship Coordinator – 352-594-5116, Email
Becky Carnes – Clerkship Coordinator, Jacksonville 904-244-8312, Email

Education Office:
Kassandra Moench– Assistant Director of Surgery Education and Training Programs
Phone: 352-594-7555; Email
Lilas Khashab– Resident/Fellowship Coordinator – 352-265-0916, Email

SURGERY CLERKSHIP GOALS and OBJECTIVES:

The third-year Surgery Clerkship strives to introduce students to the art and science of Surgery, to teach and inculcate principles, knowledge, and skills that all physicians will use in their future clinical practices. The fundamental goal of the third-year surgery clerkship is: To acquire the basic surgical skills and knowledge that will contribute to general professional education by understanding surgical diseases, treatments, anatomic and physiologic considerations including the role of the subspecialty surgeon.
Specific Objectives of the rotation are derived from the Core Competencies as below:

Learning Activities

Educational activities

There are no formal lectures during the surgery clerkship. Attendance at Friday morning Morbidity and Mortality Conference/Grand Rounds is expected. See below for more information. Additional self-study information and resources can be found on Canvas.

Clinical Education

Most education is clinical. You will be assigned to a core 1 surgery service for 3 weeks, a core 2 surgery service for 3 weeks, a two-week subspecialty elective, and trauma. Additional service-specific information can be found on Canvas.

It is expected you will spend approximately one-half day of clinic and one day of floor work per week (with variation depending on service). The rest of the time will be spent in the operating room. Students are expected to be on morning rounds, which time is dependent on each service and determined by the chief resident and may leave at 6PM after checking in with your team. Students are expected to work either Saturday or Sunday during weekends on the core rotations, coordinating days with the team unless it is your assigned trauma weekend. Students may request to work both days one weekend in exchange for a different weekend off. Students have weekends off on the switch weekend except if trauma shifts are scheduled at that time. Weekends are less time pressured such that students have more time for patient presentations, small group teaching, oral exam practice, and operative
experience.

Overnight Trauma Call Experience
All students will benefit from managing trauma. Most trauma come in overnight, therefore in order to maximize your experience, the trauma experience consists of two weekend NIGHT shifts. EVERYONE ON TRAUMA MUST TEXT Trauma Night Chief the day before your assigned call (352) 258-9345 and discuss expectations. You are excused from ore/subspecialty service obligations the Friday day before and Sunday after your trauma shifts. Weekend obligations remain in place for core rotations as specified above. The first night you are assigned to take call, report to 6PM sign-out in the 2nd floor conference room. You are expected to attend ALL trauma alerts and operative cases overnight. Post call you are
expected to leave after morning rounds, which end before morning sign out. Trauma shears are in the call rooms – please leave them for other students. Similarly, pagers are to be handed off to the next student. Trauma participation is evaluated by a Does not meet/Meets/Exceeds expectations scale.

Small Group
Small group is an eight-week curriculum covering core surgery topics tested on the oral exam and NBME. It is taught by surgical faculty and chief residents. Topics covered include:
Trauma, Burns, Appendicitis, Cholecystitis, Diverticulitis, Pancreatitis, AAA, Carotid Artery Disease, Venous Thromboembolism, Adrenal Adenoma, Thyroid Disorders, Hypercalcemia,
Anorectal Disorders, Bowel Obstruction, Colon Cancer, Breast Cancer, Skin Cancer, Inguinal Hernia, Pediatric Hernia, Pyloric Stenosis, Bariatric Surgery, Lung Cancer

These flipped classroom sessions are only successful if you read BEFORE and are prepared to answer/ask questions. Assigned readings are on CANVAS. 10% of your grade is from small group including evaluation of participation, preparation, clinical reasoning, medical knowledge, and professionalism. You are expected to initiate midpoint feedback in week 3 or 4 with your small group leader.

Simulation lab
One and a half days of simulation labs are scheduled at the midpoint of the rotation. These include:

• H&P/management simulation sessions (see canvas for introduction video)
• Suture and knot tying practice (cadaver lab)
• Surgical Anatomy lab
• Ultrasound-guided vascular access lab
• Laparoscopic simulators -various skill/coordination tasks
  Attendance is required. For an approved, planned absence, a makeup session may be discussed in
  advance.

Required Assignments
Professionalism Mini Evaluation Exercise (P-MEX)
The Professionalism Mini Evaluation Exercise (P-MEX) is an instrument used to assess professionalism in clinical training. The evaluator rates the trainee on 24 different directly observable items of medical professionalism over four different skill areas: doctor-patient relationship skills, reflective skills, time management, and interprofessional relationship skills.
You will be required to obtain the following over the course of the rotation:

• 2 to be completed be a faculty or resident with whom you closely work. You will solicit these
  yourself, which will be aimed at providing real-time formative assessment
• 1 peer evaluation, which the clerkship administrative team will assign to a peer with whom you
  work closely on one of your core inpatient teams
• Possibly 1 from the clerkship coordinator. The administrative team will assign these such that
  you receive two over the course of the year.

Clinical Documentation Requirement
You are required to write one written history and physical note, one consultation note, and one procedure note. Write ups will be reviewed and evaluated by the observing faculty, chief resident, fellow, or advanced practice provider. The write-ups may be in Epic as Student Notes. Assignments not completed will potentially result in a grade of Incomplete for the rotation. This must be an observed patient encounter – H&P/consult where the evaluator must review the write up and provide feedback to the student.

Reflective paragraph on the M&M Conference.
The student may choose to write about the process of systematic review to improve patient care, best practices for disclosing bad news or errors, benefits of reporting and discussing errors, cost-effective care, interdisciplinary care, or intersection of care, or any other topic relating to M&M. Content is intended to be reflective, and we hope you will apply a good faith effort in the spirit of the assignment. Assignments that fall clearly below a charitable threshold of a “good faith effort” will be returned for revision (e.g., obvious use of ChatGPT). assignments not completed will potentially result in a grade of Incomplete for the rotation.

Morbidity and Mortality Conference/Grand Rounds
Attendance at weekly department lectures is mandatory and is taken using a QR reader. It is expected that you are present IN PERSON unless you have off-site obligations to another service. Presentation at Morbidity and Mortality Conference allows complications to be discussed in an open forum. You will see a thorough discussion of a complication and questions asked of the presenter. Students will learn the importance of transparency and learning from one’s mistakes. The concept is that surgeons are accountable for their actions and every effort is made to discuss the relevant literature pertaining to the complication as well as possible methods to prevent such complications in the future. Patient and conference confidentiality is mandatory.
Fridays 7:00–8:00am is the time that includes BOTH conferences.
These are held in Communicore C1-15 and by Zoom

A paragraph reflecting on the M&M conference is required. The student may choose to write about the process of systematic review to improve patient care, best practices for disclosing bad news or errors, benefits of reporting and discussing errors, cost-effective care, interdisciplinary care, or intersection of care, or any other topic relating to M&M. Content is intended to be reflective and will not be graded.

Core Surgical Procedures Checklist (COSPRO)
The clerkship committee recognizes that medical students should perform some basic clinical skills during the clerkship. Students are required to keep a log documenting completion of these skills using the COSPRO form. When the student completes a skill, the resident or faculty member who has observed the procedure will sign the COSPRO form. Students will receive no credit for this portion of the rotation if a form is not turned in. Clinical experiences required by the College of Medicine that you will have on this
clerkship include:

• Interpretation of lactate level
• Interpretation of XR Abdomen
• Interpretation of CT abdomen
• Ultrasound abdomen
• FAST (trauma ultrasound)
• Peripheral IV insertion
• Simple suturing
• Documentation of procedure
• Incision and drainage of abscess
• Sterile technique
• Suture and staple removal

Required Textbooks and Resources
Surgery: A Case based Clinical Review, Christian DiVirgillio second edition, available electronically

Recommended (Not required) Textbooks
You may elect to check out surgery texts: “Essentials of General Surgery” “Current Diagnosis and Treatment – Surgery” (available online through the library) and the “Surgery USMLE Step 2 Pre- Test,” as well as a suture kit and/or knot tying board. The books, practice materials, and any other items given to you throughout the rotation are to be returned at the end of the rotation before you take the subject exam. Loss of these materials will result in a charge to replace them and the student will be responsible for that charge.

Computer Requirements
Computers are not required for coursework or in the clinical environment but are required to take NBME (SHELF Exam).

Personal Laptops
Personal laptops can be utilized in clinical spaces and should meet the computer requirements laid out by the College of Medicine (https://osa.med.ufl.edu/support/policies-procedures/computerrequirement/). While desktops are typically available on all clinical rotation sites it is recommended that you bring a personal laptop in case a desktop is not available. Laptops can be safely stored at UF Health GNV in lockers in the student lounge (North Tower Room 4207), lockers in the team rooms at the VA, and lockers in the Dr. Haley Medical Student Lounge at UF Health Jax (4th Floor Clinical Center).

Formative Feedback
Feedback is an essential part of student learning and informal feedback occurs throughout the clerkship. Faculty and residents’ feedback should be specific, constructive and non-judgmental. The faculty member and the student should jointly develop a plan to address any perceived areas of student deficiency. A formal mid-point feedback session is required using the midpoint feedback form on both core rotations. Students must contact the education point person (see table above) to provide midpoint feedback halfway through each core rotation. Additionally, midpoint feedback is strongly recommended during the small group. Students are expected to initiate midpoint feedback by completing a self-assessment form and bringing this to the faculty/senior resident. Students are required to initiate and obtain written formative feedback from a faculty member and submit at the end of the rotation. This includes a self-assessment by the student that should be shared with the faculty member to facilitate the feedback session. Students are STRONGLY encouraged to obtain written
formative feedback from all supervisors with whom they have significant contact.

ASSESSMENT

The surgery clerkship employs a competency-based system of student evaluation. Every effort is made to make this process as transparent as possible.

GRADES
The Grade Committee reviews and determines every student’s final grade.
Final grade distributions will be reviewed at the end of the year and some grades may be adjusted up at that point. No grades will be adjusted downward. This does not apply if a clerical error occurred when entering the grade.
A 90-100
B+ 85.0-89.9
B 80.0-84.5
C+ 77.0-79.9
C 70.0-76.9
F <70.0
Fail < 70 or Oral exam x 2
Oral Exam Note: A student who fails on 2 or more oral exams cases will receive an Incomplete for the surgery clerkship until they successfully remediate by retest (preferably with the clerkship director) and receive a passing score. Remediations cannot occur during other clerkships. Once a passing score is received, the highest score they will be eligible to receive in Surgery will be one grade lower or minimum of a “C”.

A student will have failed the Surgery Clerkship if one of the following occurred:

1. Overall cumulative score of less than 70%
2. Failing the Retake Oral Exam (defined as 2 or more question failures)
   

Role of the Grade Committee
All grades are discussed and finalized by the Grade Committee, composed of the Clerkship Director, Jacksonville Clerkship Director, Associate Clerkship Director(s), Fourth Year Clerkship Director, General Surgery Program Director and Associate Directors, Administrative Chief Residents, and the Assistant Director of Surgery Education. Grades will be reported within 5 weeks of the end of the rotation. Each student will receive a copy of the summative evaluation form with narrative comments reviewed by the Grade Committee that accurately reflects and incorporates observations from residents and attendings.

Required clinical presentations, skills, and procedures
The clerkship is designed to expose you to the following core presentations, skills, and/or procedures, which are graduation requirements. If you have difficulty meeting any of these, an alternate method can be used including simulation. Alternative methods are seen in parentheses.

Video instructions on how to complete case logs in New Innovation are on the Phase 2 Canvas Page.

University of Florida Competencies (Summative Form)
Faculty and Residents should have sufficient contact to appropriately evaluate student performance. The education point person faculty member on core rotations is sent an evaluation to complete. It is the expectation that a single service combined summative evaluation is completed with input from faculty, residents, and advanced practice providers, where applicable. The two core evaluations will be averaged to generate the clinical score. Competencies are weighted as follows:
Interpersonal Communication Skills (12.5%)
Patient Care (15%)
Applied Medical Knowledge (2.5%)
Practice-Based Learning and Improvement (5%)
Systems-Based Practice (5%)

On-Demand Evaluations
Clerkships now offer on-demand evaluations in New Innovations, giving you the ability to request evaluations directly from the faculty and residents you work with. You’ll be able to choose who evaluates you, generate the evaluation request yourself, and New Innovations will immediately send them a prompt to complete it. (On the faculty/resident side, the evaluation form will look the same—it will just arrive sooner.)
This system is designed to help you receive more timely and meaningful feedback, since you can request an evaluation shortly after working with someone, rather than relying on evaluations submitted at the end of the rotation, often weeks later.
Each clerkship will provide guidance on how many evaluations you are expected to initiate and when you should submit these requests. Clerkships may also continue to initiate evaluations on your behalf when needed.
If you have questions or concerns, please reach out to your course administrator. For technical issues with New Innovations evaluations, contact Michael Bruce.

The faculty members are responsible for timely completion of the on-line evaluation form. Evaluators must provide written comments regarding student performance and behavior. These comments should follow these guidelines:

1. Written comments regarding student performance should be directly observed and specific.
2. Written comments should consistently reflect the level of competency assigned for each
   core competency category.
3. The faculty should provide consistent formative feedback throughout the rotation,
   reflecting each student’s weaknesses and strengths. In cases of persistent unacceptable student
   performance, the faculty should bring this issue to the attention of the clerkship director.

Small Group
The faculty uses a fail/pass/outstanding format to assess the student’s performance, which is normalized to a numeric score (5/7.5/10 points) used to complete the final grade. The small group evaluation form is below.

Grade Coaching: A grade committee determines your final grade based on clinical evaluations, examination scores, and required assignments as outlined in the grade explanation. “Coaching up” faculty (telling them that certain numeric scores on their evaluation correlate to the grade) is misleading, unfair to the majority of students who do not do this and is considered unprofessional behavior. Engaging in this behavior will result in a lower professionalism evaluation and could affect your grade and the comments submitted for the MSPE.

NATIONAL BOARD of MEDICAL EXAMINERS SURGERY SUBTEST (‘Shelf Exam’)

The National Board of Medical Examiners (NBME) Surgery test represents the standardized test for the clerkship. A score greater than the 5th percentile is used as a marker for success in taking this examination. The NBME exam will account for 25% of the overall grade. There is no requirement for retaking the exam.

The NBME surgery subtest focuses on the application and integration of knowledge rather than the recall of isolated facts. Like all comprehensive examinations you cannot successfully cram at the last minute for this test. You need to be on a schedule of programmed reading throughout the clerkship. It is very similar to the USMLE examinations and is good practice for it as well.

The NBME Shelf will account for 25% of your Grade.

The Clerkship Director (Dr. Shaw) will take the test every 3-4 years to ensure that the subject matter is well covered during the rotation.

Oral Examination
The oral examination consists of two patient management problems presented by faculty to the student. The faculty uses a needs remediation/pass/outstanding format to assess the student’s performance, which is normalized to a numeric score (17/21/25 points) used to complete the final grade. A “needs remediation” score on 2 or more questions will require remediation by re-examination with the Clerkship Director. The oral exam will account for 25% of the grade.

Oral Examination Format
The oral examination in surgery consists of two approximately 30-minute interactions between you and a faculty member. Each session will involve TWO clinical scenarios. The faculty member will present you with an open-ended clinical presentation (e.g., a woman with a breast mass) and you must respond regarding your work-up and management of the patient. Your discussion should include the differential diagnosis of the presentation, the initial evaluation including history, physical examination, laboratory and imaging studies, and treatment including medical management, potential surgical treatment and the indications for operative intervention.

To provide greater standardization to the evaluation process, the examiner is provided a script of the question and items/responses that you should cover in your discussion of the patient (to provide objectivity to the examination in the same format as the National Board Exams).

The oral examination will be a formal evaluation of the student’s mastery of the surgery clerkship’s core discipline competencies and will account for 25% of the student’s grade.

Topics
The following are the topics that the students are expected to master as their core discipline competencies, therefore the oral examination will evaluate these same topics (see goals and objectives):
Abdominal Pain
Blunt Trauma
Breast
Burn Management
Colon Cancer
Gallbladder
Infant with Emesis
Intestinal Obstruction
Jaundice-Pancreas CA
Lower GI Bleed
Melanoma
Neck Mass/Thyroid nodule
Penetrating Trauma
Peripheral Vascular Disease
Postop Complications including oliguria and fever
Shock
Small Bowel Obstruction

Grade Meeting Requests
Medical students may appeal a grade or evaluation within one month of the posting of that grade.

You can find a link to request a meeting on the CANVAS third year web page under assessment (see below). The Clerkship Director will reach out after receiving the form to schedule.

It is on the ‘Assessment’ page towards the bottom:
https://ufl.instructure.com/courses/444568/pages/assessment

Policy on student evaluations

• Each student must complete at least 75% of all assigned faculty, resident, and small group leader
  evaluation forms associated with a course/clerkship in each year of enrollment. There is an
  expectation of 100% completion on overall course and clerkship evaluations.
• Every student is expected to respond in a professional manner to each item which she/he feels
  qualified to answer.
• Strict confidentiality of responses is assured. Evaluation data (numerical ratings and student
  comments) is de-identified.
  

SAFETY PRACTICES WHILE ON THE SURGERY ROTATION:
Getting stuck by a needle or a knife can be a traumatic experience and can be limited by ensuring proper handling of sharps. There are best practices regarding handling of sharps and you should be familiar with these. If you unfortunately are involved in a needle stick, etc. – DO NOT PANIC!
Immediately let the resident and the attending/scrub nurse know. Take off your gown and gloves and wash your hands with soap and water as well as alcohol. Call the Needle stick Hotline – 1-866-477-6824 (OUCH) – https://osa.med.ufl.edu/about/student-health-insurance-information-3/needlestickhotline-program/

Let the Clerkship director know as soon as convenient (email is fine)

Students are expected to exercise good judgment and reasonable caution in insuring their own safety during clinical experiences, (e.g., lock car doors, travel with classmates when possible, and be aware of security services). Patient care areas have the potential for exposure to hazardous substances such as radioactive materials. Students who require protection beyond those of all staff are to notify faculty prior to any clinical assignments. If any time students believe the clinical setting is unsafe, students should take appropriate steps to protect themselves and their patients, including leaving the setting if necessary. Contact the course instructor or any college administrator immediately so that appropriate arrangements can be made.

COLLEGE OF MEDICINE POLICIES AND PROCEDURES HANDBOOK

The following topics are covered in the College of Medicine Policies and Procedures Handbook

Relevant Forms and Evaluations:

1. Summative Evaluation Template
2. Clinical Evaluation Form
3. Small Group Evaluation Form
4. COSPRO Card
5. P-MEX evaluation

MDC7600 Surgery Clerkship Student Schedule
Monday through Friday, students will round with the team and attend clinical duties following rounds. Students will attend trauma call one Friday and Saturday night, and participate on inpatient rounds approximately 4 weekend days. (If asked for more: Clinical duties consist of: observing and assisting in operations, evaluating consults, managing inpatients, attending labs and didactics, and attending clinics.)