Clinical and academic staff from the Discipline of Surgery

The course timetable is available in the Course Handbook. As students undertake their placements at different hospitals and in different clinics, timetables will vary. Students are advised to consult the Course Handbook for details regarding the weekly tutorial program, end of rotation assessments and discuss with their allocated team what their particular timetable and activities are. This information should be obtained from interns and/or registrars on the allocated team.

The aim of any clinical clerkship in the MBBS curriculum is to provide the student with the opportunity to experience the art of medicine first hand. The emphasis of learning for the student should be based on the following fundamentals:
1.To develop an understanding and appreciation of professional behaviour shown by medical practitioners in the course of their duties
2. To develop the clinical skills of history taking, physical examination and case presentation, and be able to apply these skills with confidence
3.  To obtain sufficient knowledge to complement the attitudes and clinical skills learnt as an undergraduate and to be able to understand and apply this knowledge in the clinical context

4. To a certain degree, these are skills that are learnt from watching others in action and interacting with patients and colleagues, but more importantly, they are skills that are only really learnt by involvement of the student with the patient and the health professional. Whereas many of these skills can be learnt in any healthcare setting the attachments to hospital clinics should allow the student to focus on the following objectives:
* To become competent in and to learn the importance of thorough history taking
* To appreciate the art of listening to the patient
* Be able to undertake a competent physical examination
* To be able to accurately elicit and interpret physical signs
* To learn the value and place of investigations in the management of a particular illness
* To understand the principles of decision-making and management
* To display appropriate communication skills with patients and health professionals
* Appreciate the concerns, anxieties and fears of patients, their families and those providing care in the acute setting
* To appreciate the ethical, moral and social issues involved in patient care
* To develop an appreciation of cost-benefit analysis in medical practice
* To develop a critical faculty based on evidence-based medicine

5. Whilst the above principles apply to any and all branches of medicine, within the discipline of surgery, students should appreciate the following aims:
* Develop an understanding of the principles of surgery
* Acquire the clinical skills to manage patients with surgical disease
* Learn the core curriculum
* Develop a sense of perspective of surgery in the arena of health care

6. By the end of Year IV a student should be able to demonstrate:
* Attitudes and communication skills appropriate to working with patients, peers and staff on surgical units
* Competence in taking a history and performing a physical examination on surgical patients
* The ability to produce a clear and concise surgical case write-up of history and examination findings, with appropriate differential diagnoses
* The ability to give a clear oral surgical case presentation based on summary and synthesis of history and examination findings
* The ability to generate an appropriate differential diagnosis, and demonstrate problem solving skills for important and commonly seen surgical conditions
* Knowledge of routine/common investigations in surgical patients (laboratory, radiological, etc) including their appropriate sequence and urgency and correlation of results with diagnostic hypotheses
* An understanding of the principles of surgical management, particularly with respect to an understanding of the relevant anatomy, physiology and pathology underlying important and common surgical diseases.
* The ability to safely and competently perform basic practical procedures (e.g. venepuncture, urethral catheterisation and injections)

Clinical Problems in Surgery
7. Students are expected to have a thorough understanding of the following by the end of Fourth Year:
* Acute abdominal pain
* Digestive tract bleeding
* Jaundice
* Vomiting
* Change in bowel habit
* Weight changes
* Neck swellings
* Scrotal swellings and pain
* Calf pain
* Groin swellings
* Skin lesions
* Breast lesions
* Haematuria
* Acute and chronic limb ischaemia
* Venous thromboembolic disorders

General principles of Surgery
Familiarity and general understanding of the following areas is expected:
* Indications for surgery
* Preoperative assessment
* Informed consent
* Venous thromboembolism prophylaxis
* Antibiotic prophylaxis
* Patient safety in the operating room
* Post-operative care
* Pain management
* Fluid balance
* Wounds and wound healing
* Fever
* Shock
* Discharge arrangements
* Long-term follow-up and surveillance
* Late complications

8. Students are expected to become familiar with the following subjects during Fourth Year and competent with regard to knowledge and understanding of these areas by the time of graduation:

Essentials of Surgical Practice:
* Pre-operative assessment
* Post-operative management
* The acute abdomen
* Trauma
* Skin, soft tissue and hernias

Gastrointestinal Surgery:
* Carcinoma of the oesophagus
* Carcinoma of the stomach
* Peptic ulcer disease
* Gallstone disease
* Pancreatitis
* Carcinoma of the pancreas
* Inflammatory bowel disease
* Appendicitis
* Colorectal cancer
* Diverticular disease
* Anal and perianal disorders

Breast-Endocrine Surgery:
* Carcinoma of the breast
* Benign breast disease
* Goitre
* Thyroid tumours
* Adrenal gland disease

Vascular Surgery:
* Abdominal aortic aneurysm
* Peripheral vascular disease
* Carotid artery disease
* Deep venous thrombosis
* Varicose veins

Head & Neck Surgery:
* Salivary gland tumours
* Carcinoma of the larynx
* Oropharyngeal tumours
* Deafness
* Ear infections
* Facial nerve palsy
* Sinusitis
* Nasal polyps

Urology:
* Stone disease
* Renal cell carcinoma
* Carcinoma of the prostate
* Bladder neck outflow obstruction
* Testicular cancer
* Testicular torsion

Plastic Surgery:
* Principles of wound healing
* Common hand problems
* Brachial plexus problems
* Burns* Soft tissue infections
* Skin tumours

These lists are not exclusive and students are expected to have a working knowledge of all the conditions they come into contact with through patients on the wards or in the rooms.

Not applicable

* Essential Surgery. Burkitt HG, Quick CRG, Reed JB. Fourth Ed. Churchill Livingstone. 2007
* Clinical Problems in Medicine and Surgery. Devitt PG, Mitchell J, Hamilton-Craig C., Elsevier. Edinburgh. 2011. www.fleshandbones.com
* Textbook of Surgery. Tjandra JJ, Clunie GJA, Kaye AH, Smith JA. Blackwell Publishing. 2006

http://www.emedici.com: this site contains the online case studies. To gain access to the eMedici cases go to www.emedici.com. Please register there to gain access to your cases. Details of many of the problems, topics and diseases with which the graduating student is expected to have a clear understanding with respect to their recognition and principles of management can be found in the eMedici modules.

Whilst this nine-week component of the MBBS program is mainly focused on individual clinic attachments there are a number of central activities to which all students are expected to attend and contribute.

These involve weekly tutorials, starting at 2pm and held either at the Royal Adelaide Hospital (Conference Room, Level 6, Eleanor Harrald Building) or the Queen Elizabeth Hospital (Main lecture theatre, 2nd Floor).

Rural students are only expected to attend the final Friday session in person.

Home Units and Specialist clinic attachments.
During this attachment, students are expected to integrate into the Home Unit and participate in all that unit's activities. Activities on the Home Unit are expected to take priority over other curriculum activities, and these will include attendance and participation in:
* Out-patients
* Ward rounds
* Operative procedures
* Admission of elective and emergency cases

Students must realise that the amount of formal tuition (lectures, tutorials) on a home unit will be limited and every interaction, such as a ward round or out-patient clinic should be considered a learning opportunity. These opportunities may involve presentation of a case or discussion of a patient’s problem. To get the most out of the attachment, students will become actively involved in patient management to the extent of trying to see each patient when they attend the out-patient clinic, emergency department or are admitted to the ward. Students should try and present clinical material (to the interns, registrars or consultants) whenever possible.

Details of the home unit’s activities can be obtained either from that particular unit’s secretary, or more practically, from the junior staff on that ward.

Attendance in the operating room
Whilst the focus of a surgical clinic might be considered the operating room, a lot of time can be wasted standing around watching members of the unit operate. If student’s cannot scrub up or there is minimal communication from the staff at the operating table, there is probably little point in being in the operating room, and their time would be better spent on the wards or at an outpatient clinic. Students do not need to attend every clinic operating list. However if there is a particular patient they have seen in the outpatient clinic or on the ward, they should try and get involved in any procedure that might be performed on that particular patient.

The emergency room
Every general surgical unit is involved in the hospital’s emergency call roster. Often the best time to see and experience clinical medicine as it happens, is when the unit is on take. Students should ensure that they are available to attend emergencies when they are admitted, and often this is best done by giving mobile phone details to one of the unit’s interns. Depending on the hospital and friendliness of the emergency room staff, this attachment provides good opportunities for doing simple emergency room tasks, such as inserting intravenous cannulae and suturing.

Admissions for elective surgery
Most patients are admitted on the day of surgery and the short time interval prior to the procedure is insufficient for students to see them. However, these patients usually attend a hospital clinic in the week preceding their operation for assessment by the interns and/or the anaesthetists. Students should try and attend these pre-admission clinics.

Attendance at other units’ clinics
It is important that during the nine-week attachment students try to see a broad range of surgical problems. With the current numbers of students it is difficult to provide a broad-based surgical experience for everyone. Even in the hospitals where students have rotations to two units, it is unlikely that the full spectrum of general surgery will be seen within the confines of those units. To see the broad perspective of general surgical problems, it is appropriate that students consider what learning opportunities might be offered by other surgical clinics at the hospital to which they are attached.

For example, attendance at a breast or ENT clinic might provide a valuable learning opportunity for students who might not otherwise see patients with such problems during their nine-week attachment. A request to the medical practitioner running a particular out-patient clinic will generally be met with a positive response.

Self-directed study, online learning and formative assessment
Whilst the focus of the Surgical Home Unit attachment is clinical experience, students are expected to allocate the equivalent of half a day a week to self-directed study. Depending on the particular Unit’s work schedule, it may not always be possible to allocate an exact half-day to such activities and students must use their own initiative to make such time available.

The eMedici website (www.emedici.com) has been specifically designed to provide case-based studies to supplement the clinical program and to promote self-directed study.

Attendance at the School of Medicine Teaching Series is mandatory. Attendance will be monitored and will form a component of the assessment process of the Surgical and Medical Home Unit attachments.

Intra-hospital activities
Each of the hospitals will have other activities which students are encouraged to attend. These include medical and surgical grand rounds and specialists meetings. Details are available from the Clinical Studies office in each particular hospital.

Workload for the individual students will vary from week to week but students can assume that on average they will work a 45 hour week which will include clinic sessions, lectures (both delivered and online), seminars, tutorials and private study but does not include after hours call.

See Learning & Teaching Modes above

It is an MBBS entry requirement to obtain a police checks as set out in letters of offer to prospective students. Other requirements will be advised at the start of the course.

The predominant learning method for the MBBS Program is small group discovery learning.

The OSCE and written examinations held on the last Friday of the attachment are held centrally (RAH) and all students (including rural students) are expected to attend.

The assessment process of the Fourth Year Surgical Attachment has two aims:
* Provide Faculty with a measurement of the student‟s overall performance
* Provide the individual student with feedback on performance and progress made during the attachment

In more detail, the assessment has three domains:
* Professionalism
* Clinical competence
* Knowledge, understanding and analysis

Professionalism can be defined as the pursuit, attainment and practice of the methods, attitudes, qualities, ethics and values expected of a member of the medical community. These attributes go beyond clinical competence and the application of knowledge and are a reflection of the fitness of an individual to pursue a career in medicine. These attributes are best appreciated, learnt and put into practice through the everyday experience of working in the clinical environment.

The discipline of effective communication and sound clinical skills are of fundamental importance in medicine and in part depend on a sound knowledge base.

Knowledge goes beyond rote learning and involves the understanding, analysis and synthesis of the essential core of knowledge required of the competent medical practitioner.

These domains are assessed in several different ways and all the components are integral in the overall assessment. To pass the attachment a satisfactory performance is expected in each component.
* Ward report
* Topic presentation
* Written (computer-based) examination
* Attendance at the School of Medicine Teaching Series
* OSCE

Ward Report
The Ward Report focuses on the Professionalism domain, although some consideration is given to assessment of clinical competence and knowledge. Each student is expected to submit two ward reports. The first must be completed at the end of the first attachment and handed up no later than a week after finishing that component of the attachment. The ward report for the second attachment must be handed up no later than the last Wednesday of the attachment.

For those students doing a single attachment over the 9 weeks, they must submit a mid-term assessment. This report is to be handed up by week 6. These reports will focus on professional attributes (attendance, enthusiasm, participation in unit activities, approach to work, ethics and interaction with staff and patients) and clinical competence.

Topic Presentation
During the nine-week attachment students are required to make a formal topic presentation. Students will work in groups and will give their presentation on the date allocated. The topics are to be selected from those provided on the eMedici website.Each presentation will be 15 minutes (10 minutes presentation and 5 minutes discussion). Each member of the group is expected to contribute to the presentation. The formal presentations will be held on Friday afternoons (see p.4-5) in the conference room on level 6 of the Eleanor Harrald Building, RAH. All metropolitan students are expected to attend every session.

Summative Written Examination
This is the main knowledge-based assessment of the Surgical Home Unit attachment. The examination is based on knowledge about surgical illness that should have been seen and/or learnt about during this nine-week attachment. It is recognized that few students will get the opportunity to experience the broad range of surgery-in-general and for that reason it is strongly recommended that the clinical scenarios provided in eMedici are studied. eMedici is online learning resource developed specifically to provide formative assessment in the style of case-based clinical scenarios. Within the eMedici website are a number of modules (General Surgery, Gastrointestinal Surgery, Breast-endocrine surgery, Vascular, Urology) focused on undergraduate learning which students are encouraged to study. Details of this examination will be provided during the attachment

School of Medicine Teaching Series
Attendance at the program is mandatory. Random checks of attendance will be made.

Objective Structured Clinical Examination (OSCE)
This is the main assessment of clinical competence of the Surgical Home Unit assessment. An OSCE will be run in the last week of the SHU attachment. This examination will form an integral part of the overall SHU assessment. Details of the venues will be posted on the electronic Bulletin Board nearer to the time. All students will assemble at 8.00am to be briefed on the format of the examination.

Students must attend 90% of the core structured learning activities to achieve a pass in this course. Exemptions to mandatory attendance requirements may be granted by the Program Coordinator in consultation with the relevant course coordinator and year level advisor if there are exceptional medical, compassionate or extenuating circumstances as defined by the Modified Arrangements for Coursework Assessment Policy.

Apart from feedback provided by members of the clinic staff during the individual attachments, there will be a formal meeting on the last Friday afternoon of the nine-week program. To ensure that appropriate feedback is provided to individuals, it is important that the documents that make up the components of the assessment (i.e. the ward report and topic presentation assessment sheet) are delivered to the Secretary in the Department of Surgery no later than the Wednesday of the final week. The onus is on the individual student to get this material to the Department. Students cannot be awarded a mark for the attachment if they fail to deliver the required reports.

At this feedback session, students will be provided with a detailed analysis of their performance on the surgical attachment. This is designed to be more informative that the grading system required by the Medical School.

Not applicable

MEDIC ST 4016BHO

Grades for your performance in this course will be awarded in accordance with the following Grades for your performance in this course will be awarded in accordance with the following scheme: GS4

GS4

Grade	Description
NGP	Non-Graded Pass
S	Satisfactory
U	Unsatisfactory
F	Fail

In addition, students will receive a banded result upon completion of their attachment.

Five bands are available to determine the assessment in fourth year of MBBS.  The Bands available for determining student performance are:
A  Above expected competency for Year 4
B  Clearly at expected competency for Year 4
C  Just reaches expected competency for Year 4
D  Below expected competency for Year 4
E  Far below expected competency for Year 4        

Any submission details will be outlined at the beginning of the attachment.

The MBBS Program has a regular program of evaluation.  In addition, student representatives are appointed to MBBS committees and are encouraged to report on issues of importance to students.

Students may access the University Health Practice, 61+ 08 83135050
http://www.adelaide.edu.au/student/health/
The MBBS Program website has details on Student Well-being resources which can be accessed.

Please read the MBBS Program Code of Conduct