Emergency Surgery/Trauma Service
Course Goals & Objectives:
- Learn the initial management and resuscitation strategies for treating patients in shock, especially hypovolemic shock.
- Learn the basic techniques for evaluating injured patients.
- Learn the differential diagnosis and diagnostic algorithm for patients with common, non-traumatic surgical emergencies such as peritonititis.
- Learn the principles of post-operative care of surgical patients.
- To provide care for assigned patients admitted to the trauma service under the supervision of surgical residents and attending surgeons.
- To participate in daily rounds on all patients admitted to the Emergency Surgery / Trauma Service.
- Scrub on operations on injured patients or those requiring emergency procedures.
- Participate in the initial evaluation of urgent surgical consults from the emergency room and the non-surgical wards.
- Participate in the various conferences of the surgery department with particular emphasis on the trauma conference.
Course Goals & Objectives:
- Integration of basic knowledge regarding the anatomy and physiology of the gastrointestinal tract into the management of patients with colorectal and gastrointestinal diseases.
- Develop a differential diagnosis and diagnostic algorithm for patients with common colorectal and gastrointestinal diseases.
- Understand the basic anatomic and physiologic principles underlying surgical and endoscopic procedures relevant to colorectal surgery.
- Technical skills to be learned on this elective include:
- History & physical examination skills of patients with diseases of the gastrointestinal tract.
- Preoperative evaluation strategies for patients with colorectal or gastrointestinal diseases.
- Flexible sigmoidoscopy, proctoscopy, anoscopy, esophagogastroduodenoscopy, and colonoscopy.
- Observing major abdominal procedures involving the gastrointestinal tract.
- Post-operative care of patients undergoing major abdominal operations.
- To participate in daily rounds on all patients admitted to the endoscopy & colorectal surgery service.
- Attend relevant surgical conferences, including surgery grand rounds.
- Scrub on and assist in operations on patients with diseases of the gastrointestinal tract.
- Read assigned material.
- Assist the residents on the service in clinic, surgical suites, and endoscopic suites.
Total Care of the Burn Patient
Course Goal & Objectives:
- Proper technique of burn dressing.
- Management of burn wound, including:
- debridement with and without anesthesia,
- cautery excision of full thickness burns,
- heterografting principles suing frozen pigskin and cadaver skin.
- Proper resuscitation methods for severe burns and monitoring techniques.
- Develop an understanding of the pathophysiological changes which accompany burning.
- Review of the energy requirements of the burned child.
- Homografting, use of dermatones, mesher, and application of skin grafts.
- Introduction to Intensive Care as it related to the thermally injured patient.
The student will work one on one with resident assigned to the Burn Center. Daily rounds including attending the burn dressing changes.
Surgical Oncology/Breast Service
with Kent Westbrook, M.D.
Course Goal & Objectives
- History and physical examination of patients with breast disease, endocrine tumors, and melanoma.
- Preoperative evaluation of patients.
- Work-up and presentation of patients in clinic.
- Interpretation of abnormalities of mammogram, breast ultrasound, and MRI.
- Basic surgical principles while observing and assisting in surgical procedures.
- Techniques of insertion of central venous catheters.
- Integration of basic knowledge of anatomy, pathology and physiology of the breast, endocrine organs, and skin into the management of patients with disease.
- Develop understanding of the multidisciplinary aspects involved in the care of oncology patients.
- Recognition of risk factors and genetic influences on cancer incidence and the implications for patients and their families.
- Daily rounds with resident and/or staff on service.
- Work-up of patients in Women’s Oncology Clinic and Melanoma Clinic and presentation to staff.
- Observe/assist on surgical cases as scheduled.
- Read appropriate assigned material.
- Attend conferences including weekly Breast Conference, Melanoma Conference, Tumor Board, Surgical Grand Rounds, M&M and Journal Club.
- For interested students, develop a case presentation/clinical research project for presentation and/or publication.
Course Director: Deidre Wyrick, M.D.
Duration: Four weeks
Course Goal & Objectives
- Basic surgical procedures including suture closure of simple lacerations, incision and drainage of superficial abscesses, difficult vascular access, chest tube placement, etc.
- Basic wound care.
- Basis ostomy care.
- Manual reduction of an incarcerated inguinal hernia.
- Familiarity with the surgical emergencies of infancy and their presentation.
- Diagnosis and management of the more common surgically correctable, congenital anomalies:
- diaphragmatic hernia,
- esophageal atresia,
- duodenal atresia,
- jejunal/ileal atresia,
- meconium ileus,
- Hirchsprung disease,
- imperforate anus, and
- anterior abdominal wall defects.
- Diagnosis and management of the common surgical condition of childhood:
- acute appendicitis,
- hypertrophic pyloric stenosis,
- umbilical hernia, and
- inguinal hernia.
- Diagnosis and management of the acute surgical abdomen.
- Diagnosis and management of the major solid tumors of childhood.
- Evaluation and management of the child with multiple injuries.
- Basic pre- and postoperative care including fluid and electrolyte management, surgical antibiotics, nutritional care and respiratory care.
- Basic principles of surgical follow-up.
- Daily ward rounds with student, residents and staff.
- Participation in preoperative and postoperative care.
- Participation in appropriate operative procedures.
- Participation in weekly general clinic.
- Participation and attendance at appropriate pediatric and surgical conferences.
- Appropriate reading.
This rotation is designed to expose the fourth-year medical student to the field of vascular surgery in a more detailed fashion and to add to the knowledge obtained during the third year. The student will be able to understand the basic and clinical science of pre-op, operative, and post-op vascular disease processes including aneurysm disease, carotid disease, and peripheral vascular disease.
- Proper history and physical examination of vascular surgical patients.
- Understanding of vascular lab studies.
- Pre-op evaluation of patients with vascular disease.
- Management of vascular patients in post-op SICU setting.
- Integration of basic science into surgical management of patients with vascular disease.
- Basic surgical skills of wound care.
- Basic vascular radiology skills and anteriography interpretation.
- Principles of hemodynamics including hemodynamic profile and how to select appropriate therapy based upon this data.
- Pulmonary physiology applied to respiratory failure and care of patients on mechanical ventilation post-operatively.
- Daily rounds with staff and residents on vascular patients.
- Closely follow post-op vascular patients and report to vascular fellow or staff.
- Attend weekly vascular clinic.
- Scrub and assist on selected vascular cases.
- Read selected literature and peripheral literature appropriate to vascular surgery and SICU care.
- Attendance at appropriate weekly conferences such as Grand Rounds, M&M, etc.
- Assist with various procedures in the SICU.
- One-on-one conference with Dr. Moursi or Dr. Eidt 1-2 hours per week.
Congenital Cardiothoracic Surgery
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.
- To become more familiar with cardiac anatomy and anomalies.
- To gain an understanding of pathophysiology related to cyanotic and acyanotic congenital cardiac diseases.
- To better understand and describe the pre-operative management and various techniques to diagnose and manage a patient with a congenital cardiac defect.
- To better understand and describe the principles of pre/post-operative monitoring of the congenital cardiac patient.
- To become familiar with various cardiovascular drugs used in the critical care management of the congenital cardiothoracic surgery patient.
- To become familiar with the interpretation of electrocardiographic, echographic and angiographic abnormalities in patients undergoing congenital cardiac surgery.
- To gain an understanding of the risks and benefits of cardiothoracic surgery.
- To understand the rationale for the selection of candidates for surgical treatment(s).
- To learn the basics of surgical principles as applied to the congenital cardiac surgical patient.
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.
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.
- To develop an understanding of the clinical approach to diagnosis and management of various forms of cyanotic and acyanotic congenital cardiac diseases.
- 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.
- To appropriately interpret both non-invasive and invasive data acquired regarding cardiac diseases in neonates, infants, children, and adults with congenital cardiac disease.
- To assist in the clinical preparation and plan required prior to operative interventions in neonates, infants, children, and adults with congenital cardiac diseases.
- To develop an understanding of echocardiography and the basic interpretation of echocardiography in congenital cardiac diseases.
- To develop an understanding of the use and interpretation of invasive cardiac catheterization and its utility in diagnosis and treatment of congenital cardiac diseases.
- To gain exposure to a multitude of operative interventions designed for the palliation and/or correction of a broad spectrum of congenital cardiac diseases.
- 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.
- To participate in the post-operative clinical care management of neonates, infants, children, and adults recovering from cardiac surgery.
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.
Plastic & Reconstructive Surgery
Course Goals & Objectives
- Wound management.
- Basic and advanced suture techniques with various types of wound repair.
- Application of skin grafts.
- Scar revision.
- Tissue expansion.
- Myocutaneous flaps
- Assist in surgery
- Principles of wound healing.
- Management of straightforward and difficult wounds.
- Exposure to all aspects* of aesthetic and reconstructive plastic surgery.
- Congenital anomalies and craniofacial surgery*.
*Dr. Kris Shewmake (Private Practice)
The students will participate in all aspects of plastic surgical evaluation and treatment. He/she will learn the nuances of dealing with aesthetic and reconstructive plastic surgical patients from preoperative evaluation to intraoperative techniques to postoperative management. The experience will be at all three hospitals associated with the University of Arkansas for Medical Sciences campus as well as some exposure to the private group of clinical faculty. Students will be asked to assist in obtaining the preoperative history and physical on the reconstructive patients along with the general surgery resident. Students will be expected to participate in the operating room as either first or second assistant and will be allowed to assist in closing wounds. Postoperative ward work will be expected. Appropriate reference material will be provided.
Students can expect to participate in from 10 to 15 procedures per week and in the evaluation of approximately 15 to 40 patients per week as seen in the clinic.
Basic required reading will be from one of the recognized plastic surgery textbooks and from a provided syllabus.