MDC 7650
Required Neurosurgery Selective

Course name: Neurosurgery Selective
Course number: MDC 7XXX
Credit hours: 4
Course web page

Optional information: Brian Hoh, MD; Department Chair

COURSE INFORMATION

Course Description

This rotation in Neurosurgery is an experience in the management of injury and illness of the neurologic system. The 4th year student (aka, Sub-intern or Sub-I) will function as an integral part of the faculty led team caring for patients on the neurosurgery service at Shands Hospital at UF and the Malcolm Randall VA Medical Center.
Sub-I’s are expected to demonstrate enthusiasm for their work and an active interest in learning the nuances of advanced neurosurgical care. Sub-I’s will round each morning with the resident and attending teams, and will then spend time in the operating room. They will be expected to learn about neurosurgical conditions, their diagnosis and treatment. They will participate in a wide breadth of neurosurgical operations on a daily basis. Sub-I’s will assist the junior and senior residents in patient care, in the neuro-intensive care unit and on the neurosurgical ward. Sub-I’s will also participate in outpatient clinic management of pre and post-operative patients. They will also have weekly 24- hour inpatient overnight call responsibilities during which time they will see inpatient and emergency room consultations, perform supervised bedside procedures and perform appropriate documentation.
The Sub-I is expected to function at the level of an intern but with more oversight and supervision. Responsibilities include initial patient evaluation in the emergency department, clinic, and inpatient setting; continuity of care through inpatient rounding; development of surgical technique; and call / weekend duties averaging 1 in 4. Rounds are conducted daily. Weekly conferences include pre-op, case review, TTP, quality, grand rounds, visiting professors, etc.

Course Objectives or Goals

1. General Skills and Knowledge
   • Gather a history and perform a physical examination and document a clinical encounter inthe patient record – perform a competent neurological evaluation including relevant historyand neurological examination.
   • Prioritize a differential diagnosis of neurosurgical disease following a clinical encounter
   • Recommend and interpret common diagnostic and screening tests.
     • Radiology – understand the fundamentals of x-ray and computerized (CT, MRI)imaging of the spine and head, including normal and common pathological entities.
   • Provide an oral presentation of a clinical encounter with a neurosurgical patient.
   • Recognize a patient requiring urgent or emergent care and initiate evaluation and management – understand the clinical manifestations of acute and chronic intracranial hypertension, as well as other neurosurgical emergencies (infection, spinal cord compression, trauma, etc.) and principles of emergency management.
   • Collaborate as a member of an interprofessional team – work with ICU and ward nursing as well as inpatient and outpatient neurosurgical and neurocritical care physician extenders.
   • Perform general procedures of a neurosurgery resident – lumbar puncture, externalventricular drain, wound debridement, shunt tap, traction, etc.
   • Participate in daily patient handovers to transition care responsibility.
2. Intracranial Disease
   • Head injury – To recognize the spectrum of mild, moderate and severe head injury and todiagnose and initiate its management.
   • Brain tumors – To understand the broad categories, presenting symptoms and management principles of brain tumors, including indications for surgical intervention and adjuvant therapies.
   • Cerebrovascular disease – To differentiate common headache syndromes with emphasis on recognition, diagnosis and management of subarachnoid hemorrhage. To recognize presenting symptoms and signs of occlusive cerebrovascular disease, and general diagnostic and treatment strategies including indication for carotid surgery.
3. Spinal Disease
   • Spinal trauma – To diagnose and initiate acute management of spine fracture, dislocation and spinal cord injury.
   • Degenerative disease – To evaluate and initiate management of spinal degenerative disc and spondylotic disease, and to recognize neural compression syndromes and indications for surgical intervention.
4. Hydrocephalus
   • To identify signs and symptoms of hydrocephalus and know the management options in children and adults.
5. Peripheral Nerve Disease
   • To diagnose and initiate the management of peripheral nerve injury and common nerve entrapment syndromes.

Learning Activities

Educational activities:

1. Clinical performance:
   • Gather a history and perform a physical examination and document a clinical encounter in the patient record – perform a competent neurological evaluation including relevant history and neurological examination.
2. Rounding, consults, patient evaluations:
   • Prioritize a differential diagnosis of neurosurgical disease following a clinical encounter.
   • Recommend and interpret common diagnostic and screening tests..
   • Understand the fundamentals of x-ray and computerized (CT, MRI) imaging of thespine and head, including normal and common pathological entities.
   • Recognize a patient requiring urgent or emergent care and initiate evaluation
3. Team discussions:
   • Collaborate as a member of the neurosurgery team and an interprofessional team –work with ICU and ward nursing as well as inpatient and outpatient neurosurgical and neurocritical care physician extenders, faculty, and residents.
4. Observation and participation in pre-post-operative and bedside procedures and care:
   • Perform general procedures of a neurosurgery resident – lumbar puncture, externalventricular drain, wound debridement, shunt tap, traction, etc.
   • Participate in daily patient handovers to transition care responsibility.

Core Competencies

1. Patient Care – Sub-I’s will evaluate and manage patients hospitalized with an acute illness. Sub-I’s will refine history and physical examinations skills learned during the third year with more of an emphasis on efficiency.
2. Medical Knowledge – Sub-I’s should be able to define, describe and discuss the following topics under medical knowledge as outlined in the course template (See pages 3-7)
3. Practice-based Learning and Improvement – Sub-I’s will continue to refine life-long learning skills which include reading about patient problems daily and applying an evidence-based approach to clinical problem solving.
4. Systems-based Practice – Sub-I’s will work effectively as part of an inpatient team including coordinating all tests, consults, and discharge needs. Sub-I’s will address patients’ resources and consequent special needs when formulating plans of care. Sub-I’s will recognize when consultation is needed.
5. Professionalism – Sub-I’s will continue to refine their professional behavior which includes placing patients’ needs first and acting as their advocate. Sub-I’s are expected to frequently perform self-assessment, recognize limitations, and seek help as needed.
6. Interpersonal and Communication Skills – Sub-I’s will work effectively as part of an inpatient team with increased autonomy compared with third year. This includes effectively communicating with all members of the health care team

Recommended Textbooks:

• Greenberg, MS., ed., 2019: Handbook of Neurosurgery, 9th edition, 9781684201372

Alternative resources:

• Brunicardi FC, et al. Schwartz’s Principles of Surgery, 9th Ed. The McGraw-Hill Companies,2010.
  • Chapter 42: Neurosurgery.
• Doherty, Gerard M (ed.), Current Diagnosis and Treatment: Surgery, 13e. The McGraw-Hill Companies, 2010.
  • Chapter 36: Neurosurgery.
• Feliciano DV., Mattox KL, and Moore EE. Trauma, 6e. The McGraw-Hill Companies, 2008.
  • Chapter 20: The Brain.

Useful Links:
http://www.neuroexam.com/ An online, interactive instruction manual on how to conduct various aspects of the neurologic exam.
http://cns.org/education/medStudCur/index.asp The Congress of Neurological Surgeons “Medical Sub-I Curriculum” that provides an excellent summary of neurosurgery topics of interest to all physicians

Dress code: Clinic – White coat and business casual for clinic no open toe shoes. OR – Scrubs.

Attendance
Attendance of lectures and conferences is required unless post call or involved in patient care. Absence from more than15% of required activities may result in failure of Professionalism competency (see below).

Excused Absences
Absences are excused according to UF guidelines, including the following:

• Illness (including psychological)
• Family medical emergency
• Participation in the wedding of a first-degree family member (travel should be scheduled to miss the minimum amount of time; only 1 weekday should be missed)
• Academic conference where a student is presenting their research
• Religious holidays

UF Attendance Policies: https://catalog.ufl.edu/UGRD/academic-regulations/attendance-policies

Sub-I’s must contact the course director and copy the course manager to obtain permission for an excused absence. Requests should be made via email as early as possible and no less than 1 month in advance for weddings, conferences, and holidays. Once permission is obtained, Sub-I’s are responsible for notifying the Office of Medical Education of the dates for the approved absence.

ASSESSMENT
Sub-I’s will be assessed on the following:
Clinical performance, rounding, consults, patient evaluations and team discussions. Including the ability to function in the capacity as team member. Each Sub-I will be expected to present on a topic of neurosurgical interest in collaboration with a faculty member. Additionally, each Sub-I will be required to complete a week of consecutive night call where performance will be evaluated.

Presentation:
Sub-I’s are expected to perform a 15-minute presentation at morning conference in the final week of the rotation. This presentation may be about any neurosurgical or neuroscience topic. This is an opportunity for Sub-I’s to present research that they may be working on during or prior to medical school. Other options include interesting case reports or brief topic reviews. Faculty from the department are available to help in preparing this presentation. Presentations will be graded on content, preparedness, time management and oral presentation skills.

Grading is Satisfactory / Unsatisfactory (S / U) based on the assessments and evaluations above.

To achieve a passing grade, students must meet specific requirements as determined by the course director, including maintaining a final average above 70%, attending and participating in required sessions, completing assignments, and demonstrating professionalism.

POLICIES

Academic Honesty
All students should understand the Student Conduct Code and Student Honor Code and be familiar with what constitutes a violation. The Honor Code specifies a number of behaviors (e.g., cheating, plagiarism) that violate this code and possible sanctions.
Students are obligated to report to the course director any violations of this code and any condition that facilitates academic misconduct. Consult the course director with any questions or concerns.

Every UF Student is subject to the following Honor Pledge
“We, the members of the University of Florida community, pledge to hold ourselves and our peers to the highest standards of honesty and integrity by abiding by the Student Honor Code. On all work submitted for credit by Students at the University of Florida, the following pledge is either required or implied: On my honor, I have neither given nor received unauthorized aid in doing this assignment. Furthermore, I acknowledge that it is a violation of the Honor Code to capture or share assessments or assignments in any manner (e.g., download, duplicate, print, transcribe), in whole or in part, including taking screen shots or images with a computer, tablet, or camera, including a phone.”

Violations of the Student Conduct Code or Student Honor Code will be referred to the ASC.

Accommodations
The University of Florida is committed to providing academic accommodations for students with disabilities. Students requesting accommodations must first register with the Disability Resource Center (DRC) (352-392-8565 https://disability.ufl.edu/) by providing appropriate documentation. Once registered, students should present their accommodation letter to the ADA Representative, Mr. Jim Gorske, who will distribute the accommodation letter to appropriate course and/or clerkship directors, as needed, as well as the testing center. The University encourages students to register with the DRC as soon as they begin medical school or upon the verification of a disability.

Evaluations
All students are expected to complete online evaluation forms for courses and clerkships and to use professional judgment in written comments. Confidentiality is strictly maintained by de-identifying responses, both numerical and written. However, completion of evaluations is tracked. Students are expected to complete at least 75% of the online evaluations for courses and clerkships. As part of professional development, there is an expectation of 100% completion of the overall course and clerkship evaluations.

Electronic Communication
All electronic correspondence to students related to assessments, grades, student academic records, and FERPA-regulated matters must be sent only to or from a Gatorlink (“ufl.edu”) email address. FERPA, like HIPAA, has specific legal and regulatory restrictions, with violations leading to adverse consequences (see http://www.registrar.ufl.edu/ferpa.html). It is against UF policy to auto-forward Gatorlink email to an outside email address (see http://www.it.ufl.edu/policies/email/electronic-mail).

Student Learning Culture
The University of Florida College of Medicine is committed to promoting a positive learning culture and treating all members of the college community fairly with regard to both personal and professional concerns. The learning culture feedback policy ensures that concerns are promptly dealt with, and resolutions are reached in a fair and just manner. Mistreatment is any decision, act, or condition affecting a student that is determined to be illegal or unjust or that has created unnecessary hardship. Mistreatment may take the form of verbal or physical abuse, discrimination for any reason, or a requirement for individual service activity that is independent of requirements for other team members. Unprofessional behavior is an action that goes against accepted professionalism standards. Unprofessional behavior may take the form of usage of unprofessional or profane language or disrespect of other physicians, health professions, learners, or patients and families. Any concerns should be reported, including anonymously, using the Learning Culture Feedback Form. Any retaliatory action against student who report grievances in good faith is forbidden by the college. The college also wants to celebrate individuals who are exemplars in contributing positively to the learning environment and facilitate such behavior becoming an inherent part of our culture. These positive interactions can also be reported by using the Learning Culture Feedback Form.

Student Professionalism Lapse Reporting
Development of professionalism is a key outcome of the medical school curriculum and is evaluated as a core competency, as described above. Lapses should be reported at the Medical Student Portal under Resources (Student Professionalism Lapse Report). Reports can be submitted anonymously and are kept confidential. Professionalism lapses by a student, faculty member, house staff, patient, or other staff should be reported through this mechanism.

College of Medicine Policies and Procedures Handbook

HEALTH AND WELLNESS

COM Office of Student Counseling (http://counseling.med.ufl.edu/) provides information on counseling, self-assessment, wellness, student resources, and student advocacy. Especially helpful are many student resource links.

U Matter, We Care: If you or someone you know is in distress, please contact 352-392-1575 or email or visit website to refer or report a concern.

Counseling and Wellness Center: Visit http://www.counseling.ufl.edu/ or call 352-392-1575 for information on crisis services as well as non-crisis services.

Student Health Care Center: Call 352-392-1161 (24/7) to find care, or visit http://shcc.ufl.edu/.

UF Health Shands Emergency Room: For immediate medical care call 352-733-0111 or go to the emergency room at 1515 SW Archer Road, Gainesville, http://ufhealth.org/emergency-room.

UF Police Department: Visit http://police.ufl.edu/ or call 352-392-1111 (or 911 for emergencies).

SUPPORT

Library Support: Visit http://cms.uflib.ufl.edu/ask to access various ways to receive assistance with respect to using the libraries or finding resources.

E-learning Technical Support: Contact the UF Computing Help Desk at 352-392-4357 or via e-mail at helpdesk@ufl.edu.