Senior Surgery Electives

Course Director: Anna Privratsky, D.O.
Phone: 501-526-6262
Duration: Four weeks

Course Goals & Objectives:

1. Learn the initial management and resuscitation strategies for treating patients in shock, especially hypovolemic shock.
2. Learn the basic techniques for evaluating injured patients.
3. Learn the differential diagnosis and diagnostic algorithm for patients with common, non-traumatic surgical emergencies such as peritonititis.
4. Learn the principles of post-operative care of surgical patients.

Specific Duties:

1. To provide care for assigned patients admitted to the trauma service under the supervision of surgical residents and attending surgeons.
2. To participate in daily rounds on all patients admitted to the Emergency Surgery / Trauma Service.
3. Scrub on operations on injured patients or those requiring emergency procedures.
4. Participate in the initial evaluation of urgent surgical consults from the emergency room and the non-surgical wards.
5. Participate in the various conferences of the surgery department with particular emphasis on the trauma conference.

Course Director: Esther Teo, M.D.
Phone: 501-364-1649

Course Goal & Objectives:

1. Proper technique of burn dressing.
2. Management of burn wound, including:
   1. debridement with and without anesthesia,
   2. cautery excision of full thickness burns,
   3. heterografting principles suing frozen pigskin and cadaver skin.
3. Proper resuscitation methods for severe burns and monitoring techniques.
4. Develop an understanding of the pathophysiological changes which accompany burning.
5. Review of the energy requirements of the burned child.
6. Homografting, use of dermatones, mesher, and application of skin grafts.
7. Introduction to Intensive Care as it related to the thermally injured patient.

Specific Duties:

The student will work one on one with resident assigned to the Burn Center. Daily rounds including attending the burn dressing changes.

Course Director: Deidre Wyrick, M.D.
Phone: 501-364-1446
Duration: Four weeks

Course Goal & Objectives

Technical Skills

1. Basic surgical procedures including suture closure of simple lacerations, incision and drainage of superficial abscesses, difficult vascular access, chest tube placement, etc.
2. Basic wound care.
3. Basis ostomy care.
4. Manual reduction of an incarcerated inguinal hernia.

General Objectives

1. Familiarity with the surgical emergencies of infancy and their presentation.
2. Diagnosis and management of the more common surgically correctable, congenital anomalies:
   1. diaphragmatic hernia,
   2. esophageal atresia,
   3. duodenal atresia,
   4. jejunal/ileal atresia,
   5. malrotation,
   6. meconium ileus,
   7. Hirchsprung disease,
   8. imperforate anus, and
   9. anterior abdominal wall defects.
3. Diagnosis and management of the common surgical condition of childhood:
   1. acute appendicitis,
   2. hypertrophic pyloric stenosis,
   3. intussusception,
   4. umbilical hernia, and
   5. inguinal hernia.
4. Diagnosis and management of the acute surgical abdomen.
5. Diagnosis and management of the major solid tumors of childhood.
6. Evaluation and management of the child with multiple injuries.
7. Basic pre- and postoperative care including fluid and electrolyte management, surgical antibiotics, nutritional care and respiratory care.
8. Basic principles of surgical follow-up.

Specific Duties

1. Daily ward rounds with student, residents and staff.
2. Participation in preoperative and postoperative care.
3. Participation in appropriate operative procedures.
4. Participation in weekly general clinic.
5. Participation and attendance at appropriate pediatric and surgical conferences.
6. Appropriate reading.

Course Director:  Lawrence E. Greiten, M.D., M.Sc.
Contact:  Dana Ledford, 501-364-5858
Location/Hours:  Arkansas Children’s Hospital, Professional Building 3, Room G3054; 7:00 a.m. start time

Description

This four-week elective offers the students clinical experience on the Congenital Cardiothoracic Surgical Service at Arkansas Children’s Hospital (ACH). Students will actively participate in the care of the congenital cardiac surgical patient, attend weekly medical/surgical cardiology conferences at ACH and scrub into surgery. Areas covered by this elective include a multitude of congenital cardiac diseases, the physiology and pathophysiology associated with congenital cardiac diseases, diagnostic testing, the pre/post-operative management of patients with congenital cardiac disease, and the current methods of operative intervention for palliation or repair. This elective is ideally suited for those students who are interested in pediatrics, cardiology, or surgery. The student rotating on the Congenital Cardiac Surgery Service will work closely with our surgeons, cardiologists, intensivists, and nurse practitioners. If the student’s interest and volume of clinical work permit, time can be spent participating in the clinical research process as well.

Goals

1. To become more familiar with cardiac anatomy and anomalies.
2. To gain an understanding of pathophysiology related to cyanotic and acyanotic congenital cardiac diseases.
3. To better understand and describe the pre-operative management and various techniques to diagnose and manage a patient with a congenital cardiac defect.
4. To better understand and describe the principles of pre/post-operative monitoring of the congenital cardiac patient.
5. To become familiar with various cardiovascular drugs used in the critical care management of the congenital cardiothoracic surgery patient.
6. To become familiar with the interpretation of electrocardiographic, echographic and angiographic abnormalities in patients undergoing congenital cardiac surgery.
7. To gain an understanding of the risks and benefits of cardiothoracic surgery.
8. To understand the rationale for the selection of candidates for surgical treatment(s).
9. To learn the basics of surgical principles as applied to the congenital cardiac surgical patient.

Supervision

The student will be supervised by Congenital Cardiac Surgery attending physicians and associate staff including nurse practitioners and operating room staff. Curriculum and content will be learned through participation on the clinical service, in the operating room, on CVICU rounds, and in outpatient clinics. Participation in the weekly Congenital Cardiac Surgery Conference(s) is expected. Outside reading of appropriate congenital cardiac surgery text chapters and publications is strongly encouraged. To augment the student’s self-directed study, several lectures will be presented by our Congenital Cardiac Surgery Team throughout the duration of the rotation.

Evaluation

Feedback will be provided throughout the duration of the rotation.  The student will participate in the pre-operative evaluation of the patient, be engaged in the operative repair/palliation, and help outline a post-operative care plan.  The student will be evaluated by the Congenital Cardiac Surgery attending physicians at the end of each rotation with emphasis on the rotational objectives listed below.

Objectives

1. To develop an understanding of the clinical approach to diagnosis and management of various forms of cyanotic and acyanotic congenital cardiac diseases.
2. To further develop clinical skills related to the assessment and treatment of a pre-operative patient in both the hospital and clinical setting, which will include performing a thorough history and physical exam, developing a differential diagnosis and treatment plan.
3. To appropriately interpret both non-invasive and invasive data acquired regarding cardiac diseases in neonates, infants, children, and adults with congenital cardiac disease.
4. To assist in the clinical preparation and plan required prior to operative interventions in neonates, infants, children, and adults with congenital cardiac diseases.
5. To develop an understanding of echocardiography and the basic interpretation of echocardiography in congenital cardiac diseases.
6. To develop an understanding of the use and interpretation of invasive cardiac catheterization and its utility in diagnosis and treatment of congenital cardiac diseases.
7. To gain exposure to a multitude of operative interventions designed for the palliation and/or correction of a broad spectrum of congenital cardiac diseases.
8. To spend time in the operating room observing cardiac bypass, the current methods of operative interventions for palliation or repair, and to actively participate in operative procedures.
9. To participate in the post-operative clinical care management of neonates, infants, children, and adults recovering from cardiac surgery.

Additional Opportunities

If the student wishes to engage in academic developmental activities such as research, we have several ongoing projects which, depending on the student’s interest(s) and time commitments, the student will be able to engage in with the ultimate goal of publication and presentation.

For senior students interested in Surgical Research, please contact Anna Privratsky, D.O., via email at Aprivratsky@uams.edu  or phone at 501-526-6262.