Salem VA Surgery Rotation

Attending Surgeons:              Gary Collin

                                                Wayne Wilson

                                                Jorge Rivera

                                                Adhiram Choudhury

 

Rotation Summary:

For medical students, the VA service provides a unique opportunity to see a vast array of surgical diseases during one rotation.  The hospital is located in Salem, Virginia and serves veterans from southwest Virginia and eastern West Virginia.  Medical students assist in providing care to these veterans while under the guise of the attending surgeons, a UVA chief surgery resident, and three UVA junior residents (usually two PGY-2s and one PGY-1).     

Learning Objectives:

Upon completion of this rotation medical students should be able to:

  1. Perform a focused history and physical examination on veterans with complex medical backgrounds who present with varied surgical diseases.
  2. Begin gaining an appreciation for inpatient acuity and changes in status based on daily face-to-face assessment of the patients, data collection (both lab and other diagnostics such as XRays), and discussion with the team.
  3. Develop a plan of care for patients both in the hospital and in the clinic settings through discussions with your team members and the attendings.
  4. Gain an indepth understanding of the pathophysiology which affects these patients for example:
    1. Colorectal cancer and other GI malignancies
    2. Hernias
    3. Peripheral vascular disease
    4. Lung cancer
    5. General hepatobiliary disease
    6. Other surgical emergencies
  5. Learn basic suturing and knot tying techniques.
  6. Develop pre- and postoperative plans of care that take into account the complex comorbid conditions that many of these patients suffer with.
  7. Deliver thoughtful, concise presentations to the chief resident and the attendings which demonstrate an understanding of the nature of the disease process, the comorbid conditions which affect its management, and the medical/surgical management of the condition
  8. Discuss indications and contraindications for surgical management in this patient population

Responsibilities:

Medical students should participate in all patient care activities, which include:

  1. Present your patients on rounds each morning and afternoon with the team to discuss patient care and develop a daily plan of care.
  2. Write daily notes on ward patients.
  3. Attend clinics on Mondays, Wednesdays, and Fridays when not in the operating room.
  4. Assist the junior residents with care on the wards and, if deemed suitable by the attendings and the chief resident, in the intensive care unit.
  5. Attend and participate in all the general surgery operations.  You should be completely prepared for every OR case prior to scrubbing in.  This means that you have reviewed the patient's history and know the results of all laboratory, radiology, and pathology studies.  In addition you will be expected to read about the patient's disease process, the treatment options, and the details of the proposed surgery, including relevant anatomy and the surgical techniques involved.
  6. Review the basic surgical principles of each case you participate in.
  7. Attend weekly conferences including grand rounds and morbidity/mortality conference.
  8. Take call with the junior residents to gain a perspective on caring for surgical patients' evening needs and dealing with emergency room consultation.