MDC7602
Sub Internship in Plastic and Reconstructive Surgery

UF syllabus policy: http://syllabus.ufl.edu/syllabus-policy/
Course name: Sub Internship in Plastic and Reconstructive Surgery Course number: MDC 7602
Credit hours: 4
Course web page: https://surgery.med.ufl.edu/education/general-surgery-residency/medical- students/

COURSE INFORMATION

Course Description
Fourth year medical students are invited to participate in a four-week sub- internship rotation that will expose students to the process of what being an intern on our service demands and requires, in addition to understanding the fundamentals of Plastic Surgery and the patients that are treated by us. This rotation is ideal for students interested in pursuing a potential career in plastic surgery and those wanting to improve their basic surgical and suturing skills. Emphasis of the rotation is on management of patients who are on service as well as understanding the requirements for consults, learning basic principles of plastic and reconstructive surgery, application of medical knowledge in patient care and clinical problems solving, and learning basic plastic surgery suturing and surgical techniques. The students will function as interns and will work closely with the residents in the operating room, during rounds and patient care. Students are expected to manage the patient list, lead the team on daily rounds, and develop a deep understanding of the systems-based management that is involved in a surgical team. The goal is to provide students with experience for a smooth transition into their intern year.

Course Objectives or Goals

The overarching purpose of the Plastic Surgery Sub I will be in line with the other Surgical Sub internships – which is a consolidation of the 13 Graduating Entrustable Professional Activities (EPA’s) that have been put forth by the AAMC. These 13 core activities span obtaining an accurate history and physical, creating a differential, and all the way to understanding the consent process, displaying adequate technical skills, and understanding the culture of safety and quality. These goals will tie in to the broad Sub I one of ensuring students are ready to assume the role of a physician who is in training and the differences from being a medical student.

These EPA’s will be assessed during the Plastic Surgery Sub I by observation and assessment of the students during the performance of their daily tasks assigned. An expectation of not only understanding the EPA but displaying continued improvement in them during the rotation will be required.

The students will gain familiarity with the pre-, intra – and post-operative management of surgical patients. Students will gain experience in the various aspects of plastic surgery including trauma, congenital and traumatic defects of face and hand, breast reconstruction, cosmetic surgery and general aspects of wound healing and infection as they relate to the skin and open wounds. Principle- based problem solving and the reconstructive ladder will be taught and emphasized throughout.

The specific course objectives are listed below applicable to the plastic surgery patient – and the associated EPA:

• Gather a history and Perform physical examination (EPA 1)
• Provide an Oral Presentation of a Clinical Encounter (EPA 5 and 6)
• Prioritize a Differential Diagnosis Following a Clinical Encounter (EPA 2)
• Observe the obtaining of Informed Consent for Tests and/or Procedures (EPA 11)
• Retrieve Evidence to Advance Patient Care – display ability for EBM (EPA 7)
• Suggest and Interpret Common Diagnostic and Screening Tests (EPA 3)
• Give AND Receive a Patient Handover to Transition Care Responsibility (EPA 8)
• Contribute to a Culture of Safety and Improvement (M & M) (EPA 13)
• Learn how to Enter Orders and Prescriptions (EPA 4)
• Display the ability to be a Team player (EPA 9)
• Document a Clinical Encounter in EPIC (EPA 5)
• Develop ability to recognize patients requiring immediate care (Pre & Post op settings) (EPA 10)

Learning Activities

Clinical instruction and learning will occur during hospital rounds, surgical procedures and outpatient clinics. The student will be expected to maintain the patient team lists and update as needed during the day. As a Sub intern, the student will lead the rounds and display knowledge of the progress and plans for each patient. Rounds will be for six days in the week – allowing one in seven days off, and the timing will differ based on conferences and OR requirements.

As an intern on Plastic Surgery would – the students will be expected to complete the rounds-based activities and patient care before the OR – this will involve prioritization of the care plans and teamwork. Notes and orders will be assessed by the residents, as well as faculty. The interns are then allowed to participate in the OR and perform appropriate parts of the procedure in which their ability to understand the physiology and anatomy of the operation, potential complications, and technical skills will be assessed. Feedback will be provided by faculty and residents immediately and in a cumulative fashion during the rotation.

In addition, each student will be required to go to at least one clinic a week as designated by the specific team they are on. In clinic, they will be assessed for their ability to obtain a history and physical, create a differential and an appropriate clinical plan including tests and an operative outline. This will include assessment of the ability to obtain informed consent (by observing the staff do it, and demonstrating to them independently beforehand)

Weekly educational sessions are held at 6:45 am Thursday and Friday mornings conducted by either faculty or residents on a plastic surgery topic in depth. Students will be expected to attend and be actively engaged in topics of discussion. Also, students will be required to participate in monthly journal club and will be assigned an article for review and discussion. Monthly preoperative conference and Morbidity and Mortality Conference are also mandatory to attend, where the student will be assessed on how to create a culture of quality and safety for the plastic surgery patients.

Finally, the student on the Sub I will be required to take night call for a six-day period which will involve home call (similar to the Plastic Surgery Interns), and a requirement to come in to assess consults or inpatients at night and work through the process of assessments, tests, plans, and active patient care.

Core Competencies

ACGME core competencies:
Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Systems-based Practice, Professionalism, Interpersonal and Communication Skills. (details provided in second document)

Recommended Textbooks

• Plastic Surgery Essentials for Students
• Grab and Smith Plastic Surgery
• Essentials of Plastic Surgery
• PSEN (Plastic Surgery Education Network)

Optional:
Business attire with a clean white coat is expected for the Grand Rounds and clinic. Scrubs are permitted in the OR only or during weekend rounds.

Attendance

Attendance of lectures, grand rounds, presentations, morning rounds and educational activities (i.e., journal club) is required. Absence from more than 20% of these activities without prior excuse will 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

Students 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, students are responsible for notifying the Office of Medical Education of the dates for the approved absence.

ASSESSMENT

Students on the Plastic Surgery Sub I will be assessed in a wholistic fashion with multiple observations in different clinical settings. These observations and the response to feedback overt the course of the rotation will be discussed by the faculty as a group and the Course Director will assume the responsibility of assembling the grade.

The bulk of the assessment (50%) will be based on direct observation of the student as described above in the various clinical settings – Rounds, Clinic, and the OR. Each student will be assessed using the modified Chen entrustment scale (different from the 9-point 3rd year students scale) that ranges from 1 (‘watch me’) to 5 (‘you do it, and I will check key things’). The end of rotation evaluation will involve all faculty and core residents on the rotation as a group.

20% of the evaluation will be based on an expected clinical presentation that the student will give to the faculty as a group. This will be a slide-based talk covering a key Plastic Surgery concept.

20% of the grade will be based on Proficiency of appropriate technical skills: Prepping and draping operative field; Surgical incision suturing; and traumatic wound suture/care
The remaining 10% will be assessed on professionalism, attendance and contributions during conferences, especially M and M.

No formal exams/tests/quizzes will be given at the end of the rotation.

Final grade will be decided by the clerkship director based on submitted evaluations. Specifically, below are grade breakdown and requirements for the rotation.

Grading

Grading will be a letter grade A-D and F. The grading will be done based on the student’s clinical evaluations and be assigned by the course director.

86% – A
81-85% – B
76-80% – C
71-75% – D
<71% – F

To pass the rotation a student must not have more than two unsatisfactory evaluations either from residents or faculty. Please see ACGME competencies for details on expectations.

Assessments and Unexcused Absences or Tardiness
Unexcused absences or tardiness will be recorded in notes for professionalism in the course.

Core Competencies
Students must satisfactorily demonstrate the following core competencies: Interpersonal and Communication Skills, Medical Knowledge, Patient Care, Practice-based Learning and Improvement, Professionalism, Systems-based Practice. Students must fulfill these competencies to progress in the curriculum.

Academic Progress
The course director reserves the prerogative to recommend that a student’s progress be reviewed by the Academic Status Committee.

Professionalism Competency
The course faculty evaluate professionalism on an S/U basis that includes these factors:

• Faculty-student interactions
• Faculty observations of student-student interactions
• Faculty observations of interactions between students and other faculty, patients, and staff
• Reports on student interactions by faculty, students, patients, and staff.
• Absence from more than 2 required course activities without prior notification or excuse

If a student fulfills the professionalism competency but there are significant behavioral or problematic attendance issues, a professional lapse report or a letter of concern may be submitted to the Associate Dean of Student Affairs.

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.

Student Conduct and Honor Codes: https://sccr.dso.ufl.edu/students/student-conduct-code

Students are bound by the UF Honor Pledge: We, members of the UF community, pledge to hold ourselves and our peers to the highest standards of honor and integrity by abiding by the Honor Code.

For all assessments and work submitted for credit, the following pledge is either required or implied:
On my honor, I have neither given nor received unauthorized aid in doing this assignment.

Violations of the Student Conduct Code and Student Honor Code will lead to referral 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 (100% of) 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 must complete at least 75% of the online evaluations for courses and clerkships. Failure to meet this goal in a timely manner will be noted as a concern for the Professionalism competency.

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 Mistreatment Reporting
An essential aspect of a conducive learning environment is the cultivation of professional and respectful interactions between faculty, staff, and students that avoid mistreatment of any kind. Mistreatment, either intentional or unintentional, occurs when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process. Examples of mistreatment include sexual harassment; discrimination or harassment based on race, religion, ethnicity, gender, or sexual orientation; humiliation; psychological or physical punishment; and the use of grading and other forms of assessment in a punitive manner (see Mavis B, et al. Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Acad Med. 2014 89:705 PMID 24667505). Mistreatment should be reported, including anonymously, at the Medical Student Portal under Resources (https://students.med.ufl.edu/about/student-mistreatment-report/).

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 (https://students.med.ufl.edu/about/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
The following topics are covered in the College of Medicine Policies and Procedures Handbook (which can be downloaded from https://osa.med.ufl.edu/policies-procedures/):

• UF Policies (e.g., honor code)
• Attendance for Required Educational Activities
• Classroom Behavior
• Unsatisfactory Performance and/or Unprofessional Behavior
• Professional Behavior
• Graduation Requirements and Recommendations
• Code of Ethics Medical
• Student Mistreatment Policy
• Dress Code
• Student Evaluations of Courses, Clerkships, and Faculty
• Social Networking Policy
• Medical Student Work/Duty Hours Policy
• Clerkships and Electives Policy for Use of Mobile Technology in Patient Care Area
• Grade Grievance
• Student Counseling and Health Care
• Appeals Process
• Technical Standards/Disability Services
• Leave of Absence
• Medical Student Meeting Travel Support
• Probation and Dismissal
• United States Medical Licensing Examination

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

U Matter, We Care: If you or someone you know is in distress, please contact 352-392-1575 or umatter@ufl.edu or visit http://umatter.ufl.edu 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