TOURO COLLEGE

Louis Primavera, Ph.D.

Dean

SCHOOL OF HEALTH SCIENCES

Physician Assistant Studies

Manhattan Campus
PAC 673 Surgery Preceptorship

Course Information:
Surgery Clinical Rotation, PAC 673, 5 Credit Hours
Location/Days/Times: TBA
Prerequisite: Matriculation in the PA Program from didactic to clinical year
Course Coordinator:
Mary Showstark MPAS, PA-C; mary.showstark@touro.edu; 646-795-4510 ext. 47113
Valerie Lederman MPAS, PA-C; Valerie.lederman@touro.edu; 646-795-4510 ext. 47112
Instructor(s) of record:
TBA
Communication Expectations:
It is requested that you check your email daily and respond within 24 hours of receipt to all school
related emails. You are required to contact your preceptor 3 weeks prior to the start of rotation.
Day(s) and time of Class:
Daily, as per preceptor work schedule. Student must be prepared to work the schedule that the preceptor
deems most beneficial. This means the student must be available 7 days and nights a week. The student
should be prepared to take call. The student should not schedule any conflicting schedules due to work
or family, nor schedule weekend vacations.
Location:
TBA
Course Description:
Students are assigned to work under the supervision of licensed surgeons and/or physician assistants and
in conjunction with the healthcare team in the Department of Surgery. In this core rotation, students
become involved in all phases of diagnosis and treatment of the surgical patient, including pre-operative,
operative, and post-anesthesia care. They learn the practical management of fluid, electrolyte and
nutritional disturbances, post-operative infections, as well as wound healing and wound care. They scrub
into the operating room and observe and assist in a variety of surgical procedures as assigned by the
preceptor(s), and also become involved in the management of the critically ill surgical patient. Students
incrementally develop the ability to analyze and synthesize medical information, to reason
independently, and to apply the concepts of medical decision-making and problem-solving to complex
patient presentations. Students are expected to attend daily rounds, grand rounds, morbidity & mortality
conferences and scheduled lectures.
Students are assigned to work directly with attending physicians and / or resident - PA staff in the
Department of Surgery. The student will become involved in all phases of diagnosis and treatment of

the surgical patient, including pre-operative, operative and post-anesthesia care. Students will learn the
practical management of fluid, electrolyte and nutritional disturbances, as well as wound care, postoperative infections and wound healing. Students will scrub into the operating room and observe and
assist in a variety of surgical procedures as assigned by the preceptor(s). They will also become
involved in the management of the critically ill surgical patient. Students are required to attend daily
rounds, grand rounds, scheduled lectures and conferences while on the surgery service.
Course Goals:
To provide students with the hands-on opportunity to evaluate and manage surgical patients in a hospital
setting.
Course Objectives:
GENERAL APPROACH TO PATIENT MANAGEMENT:
Students should follow a methodical approach when working up any patient complaint. They should:
1.
Elicit the Chief Complaint & perform a focused H & P
2.
Identify abnormalities encountered while recording the history
3.
Identify abnormalities encountered while performing the physical examination
4.
Formulate a Differential Diagnosis list
5.
Formulate a Plan of action that should include appropriate lab tests such as:
a.
bloodwork
b.
X-rays
c.
ECG
d.
U/A
e.
stool guaiac
f.
special diagnostic procedures
6.
Evaluate all pertinent labs & diagnostic data
7.
Prescribe appropriate medical therapeutic agent(s)
8.
Generate appropriate referrals
9.
Design adequate patient follow-up & assemble and provide patient education
MINIMUM LEARNING OBJECTIVES:
I.
Students are responsible for the following objectives, whether or not clinical examples are seen
during the rotation. These objectives will form the basis for the End - Of - Rotation Exam. The student
should be able to demonstrate clinical knowledge and explain the surgical treatment of the following
surgical problems:
A.
Head & Neck Disorders
1.
Intracranial tumor / Aneurysm / AVM
2.
Goiter / Neck Mass
3.
Carotid Artery Occlusion due to ASCVD
4.
Cerebrovascular Disease
5.
Pheochromocytoma
B.
Thoracic Disorders
1.
Lung Tumors
2.
Mediastinal Masses
3.
Pulmonary Embolism
4.
Pneumothorax / Hemothorax / Chylothorax
5.
Breast Mass / Breast Cancer
C.
Gastrointestinal Disorders
1.
Mallory Weiss Syndrome
2.
Esophageal Varices
3.
Esophageal Malignancy
4.
Peptic Ulcer Disease

D.

E.

5.
Gastritis
6.
Gastric Carcinoma
7.
Cholecystitis / Cholelithiasis / Cholangitis/Empyema
8.
Pancreatitis
9.
Pancreatic Malignancy
10.
Bowel Obstruction (small & large bowel)
11.
Meckels Diverticulum
12.
Diverticular Disease
13.
Appendicitis
14.
Mesenteric Adenitis
15.
Crohns Disease
16.
Ulcerative Colitis
17.
Volvulus
18.
Intussusception
19.
Colon Cancer
20.
Hemorrhoids (internal & external)
21.
Anal Fistulae & Fissures/Polyps
22.
Perirectal & Perianal Abscesses
23.
Achalasia
24.
Gangrene
25.
Acute abdomen
26.
Pseudocolitis
Vascular Disorders
1.
Thrombophlebitis (superficial)
2.
DVT
3.
Occlusive Arteriosclerotic Cardiovascular Disease
4.
Hypovolemic Shock
5.
Aortic Aneurysm
6.
Portal HTN
Others
1.
Hernias (hiatal / inguinal / incisional / ventral)
2.
Renal Calculi
3.
BPH / Prostatic Cancer
4.
Multiple Trauma
5.
Burns (thermal / chemical / electrical)
6.
Testicular tumors
7.
Shock
8.
Wound healing
9.
Abscesses
10.
Compartment Syndrome
11.
Peritonitis
12.
Testicular torsion/varicocele
13.
Obstructive uropathies
14.
Polycystic kidneys
15.
Electrolyte imbalance
16.
Fractures
17.
Lacerations
18.
Shock
19.
Herniated disc

II.
The student should be able to recognize (through appropriate use of history & physical
examination skills) and identify the differential diagnoses and management of the following postoperative complications:
A.
Fever
B.
Wound Infection
C.
Pulmonary Embolism
D.
Pneumonia
E.
Urinary Retention
F.
Ileus
G.
Constipation
H.
Renal Failure
I.
Wound Dehiscence / Evisceration
J.
Adhesions
K.
Atelectasis
L.
Arrhythmias
M.
DVT
N.
Hematoma / Seroma
O.
Suture Abscess
P.
MI
Q.
Sepsis
R.
Tetany
III.

The student should be able to demonstrate competence in the following areas:

A.
Performing an appropriate surgical admission history
B.
Performing an appropriate surgical admission physical examination
C.
Writing admission, preoperative, postoperative orders
D.
Writing operative notes, SOAP notes and discharge summaries, procedural notes
E.
Writing orders (admission / medications / blood & blood products, etc.)

IV.

The student should be able to demonstrate competence performing the following clinical skills:
A.
Venipuncture
B.
Arterial Blood Gases
C.
Insertion of Urinary Catheters
D.
Insertion of Nasogastric Tubes
E.
Insertion of I.V. Lines
F.
Suturing & Stapling Techniques
G.
Suture & Staple Removal
H.
Maintaining Aseptic Technique
I.
Assist in the Operating Room
J.
Wound Dressing & Dressing Changes
K.
Maintenance of Drains
L.
Wound Debridement
M.
EKGs

V.

The student should be able to interpret the following test results:

A.
X-rays
1.
PA & Lateral Chest
2.
Flat & Upright Abdomen
3.
Upper GI Series
4.
Barium Enema
5.
Extremity Films (to r/o fracture dislocation)
6.
HIDA Scan

B.

C.

VI.

7.
Mammography
8.
Ultrasonography
9.
CT Scan / MRI Scan
10.
ERCP
Laboratory Results
1.
CBC with Differential Count
2.
Electrolytes
3.
Arterial Blood Gases
4.
Urinalysis & Microscopic Analysis
5.
PT INR / PTT
Diagnostics
1.
Electrocardiogram
2.
Peritoneal lavage
3.
FAST Ultrasound
4.
Interventional Radiology
5.
Sigmoidoscopy/Colonoscopy
6.
Flouroscopy

The student should be able to describe and differentiate between the class, mode of action,
indications and contraindications of the different pharmacologic agents commonly associated with
the management of surgical patients:
A.
Analgesics
1.
Morphine Sulfate / Codeine
2.
Hydromorphone HCL (Dilaudid)
3.
Hydrocodone (Lorcet, Lortab, Vicodin)
4.
Oxycodone (Percocet, Percodan)
5.
Meperidine HCL (Demerol)
6.
NSAIDs
B.
Anticoagulants
1.
Coumadin
2.
Heparin
C.
Antibiotics
1.
Aminoglycosides
2.
Penicillins
3.
Broad Spectrum Agents
4.
Macrolides
5.
Tetracyclines
6.
Cephalosporins
7.
Quinolones
8.
Sulfonamides
D.
Miscellaneous Agents
1.
Benzodiazepines
2.
Stool Softeners
3.
Antacids / Histamine Blockers
4.
Atarax / Vistaril / Benadryl
5.
Epinephrine

VII. The student should be able to provide patient education concerning the disease process, diagnosis,
treatment, and preventative aspects of care to the patient and family members.
VII.

The student should be able to convey the following attitudes:

A.
Sensitivity to understand & relate to the emotional and social background of patients.

B.
C.
D.
E.
F.
G.

Relate & perform professionally in a working environment with other members of the health care
team.
Willingness to ask for help from others (when appropriate) & to utilize resources for patient care.
Openness to receive constructive criticism.
Show a general concern for patients as demonstrated by thorough monitoring of patient
progress / attention to detail and accurate record keeping.
Demonstrate that he/she has done independent outside reading concerning problems seen.
Perform duties with a professional demeanor, comprising such areas as attendance, dress and
general conduct.

Textbook and Resources:

Surgical RecallRequired (most recent edition)
Schwartzs Principles of Surgery, Brunicardi, Anderson, Billiar, et al. (eds.) Required (most recent
edition)
CURRENT Diagnosis & Treatment: SurgeryRequired (most recent edition)
Essentials of General Surgery by Peter LawrenceRequired (most recent edition)
The ICU Book by Paul MarinoRequired (most recent edition)
Additional Readings:
Preceptors may assign additional readings during the course of the rotation.
Course Structure:
Daily patient care with duties that may include, but are not limited to, General Surgery, Acute Care and
Trauma Surgery, CT Surgery, Plastic Surgery, Surgical Oncology, Pediatric Surgery, Transplant Surgery,
Vascular Surgery, Neurosurgery, Orthopedic Surgery, Urological Surgery, Endocrine Surgery,
Anesthesia, outpatient clinics, and wound care clinics.
Required Competencies:
NCCPA topics
All NCCPA topics may be seen in Primary Care. The student will be familiar with the Competencies for
the Physician Assistant and Task Areas as outlined by the ARC-PC/NCCPA/AAPA. You may find them
by referencing your Touro College Student Handbook or by visiting www.nccpa.net.
Assessment of Student Learning/ Student Learning Outcomes:
Assess a diverse population of patients and a variety of diseases and conditions specific to Surgery.
These patients are measured and recorded in TYPHON. The minimum requirement of patients logged is
10 patients per week/50 per rotation to include a minimum of each of the following: 10 pre-op/intraop/post-op. The student is responsible for completing this by Sunday of every week at 9pm. If this is
not completed 0.2 points will be deducted from your end of rotation grade.
Students will be evaluated on their medical knowledge, interpersonal and communication skills,
professionalism, practice-based learning and improvement, procedural skills, and system based practice
via their preceptor evaluation.
Other tools used to assess student clinical learning and learning outcomes during their primary care
rotation may include the following:

Mid-Rotation Evaluation
Clinical Evaluation Exercise with preceptor to demonstrate oral presentation skills, reviewed
and evaluated on preceptor evaluation form

Final End of Rotation Evaluation

End of Rotation Written or Computerized Examinations
Assessment of Knowledge and Critical Thinking Testing
Simulation Center
Patient Logging on TYPHON
Clinical Case Documentation (EMR, SOAP, H&Ps, drug cards submissions)
Case Presentations
Video Presentations
Student Evaluation of Clinical Team/Site and Clinical Educator

Grading System:
A= 93-100%
A-=90-92%
B+=87-89%
B=83-86%
B-=80-82%
C+=77-79%
C=73-76%
C-=70-72%
End of Rotation Exams: 50%
Preceptor Evaluation: 25%
Assessment of Knowledge and Critical Thinking Testing 25%
Other:
Presentation(s): Pass/Fail
Clinical Case Documentation: Pass/Fail
TYPHON Logs as previously stated above
Exam Taking/Re-testing
All students, unless otherwise indicated by their academic standing are allowed 2 EOR failures.
A student receiving a grade less than 73% on their end of rotation exam is considered failing. The
student will be required to retake the examination pending having an allotted make-up with the highest
make-up grade being 73%. A student may review their EOR exam within 5 days and fill out a question
contestation form, if necessary. No questions should be emailed or compiled outside of the exam
review.
All students unless otherwise indicated by their academic standing are allowed 1 ACKT make-up.
A student receiving a grade less than 70% on their ACKT will need to take a retake examination pending
having allotted make-ups. There are no reviews of ACKT after a failure. The student will be required to
retake the examination pending having an allotted make-up with the highest make-up grade being 70%.
Course Policies:
Students are REQUIRED to:
Attend a minimum of 45 hrs. / week at the clinical site
Attend all available conferences / rounds / lectures
Read suggested & assigned literature

Be ON-CALL & work flexible schedules which may include weekends (determined by the site)
Always be appropriately dressed
Wear school & institutional I.D. at ALL times
ALWAYS introduce themselves as Physician Assistant Students to staff, patients and families
Be on time for all rounds / meetings and other assignments
Student Responsibilities:

Elicit medical histories & perform physical examinations

Order & analyze appropriate laboratory and diagnostic tests

Perform various diagnostic and therapeutic procedures

Develop working differential diagnoses

Develop a comprehensive patient treatment plan

Have a basic understanding of the pathophysiologic & etiologic basis of disease entities outlined

All written medical records & oral presentations must be orderly, logical & thorough

Maintain problem oriented medical records, including H & Ps, SOAP notes and problem lists

Maintain respect for patients & their confidentiality AT ALL TIMES

Patient cases and data to be presented will be DEVOID of any names and M.R. numbers
Attendance/Absences
Students are allowed one absence throughout the clinical year. All absences must be reported to the
clinical coordinator and the preceptor prior to the absence. Appropriate documentation may be
requested and required, otherwise disciplinary action may ensue (refer to handbook).
Dress Code
The student must check in with the preceptor 3 weeks prior to the rotation to discuss whether the student
may wear dress clothing or scrubs. The student must always wear a short, white coat with their student
name tag visible.
ACADEMIC INTEGRITY STATEMENT
Touro College and University System is a community of scholars and learners committed to maintaining
the highest standards of personal integrity in all aspects of our professional and academic lives.
Students and faculty are expected to share a mutual respect for teaching, learning and the development
of knowledge. Because intellectual integrity is a hallmark of scholarly and scientific inquiry as well as a
core value of the Jewish tradition on which our university system was founded, students and faculty are
expected to adhere to the highest standards of honesty, fairness, professional conduct of academic work
and respect for all community members.
Academic honesty supports our shared intellectual culture and our ability to trust one another. Students
must avoid all acts of dishonesty, including, but not limited to:
cheating
plagiarizing (presenting the work or ideas of others as your own)
fabricating (making up information, data, or research results)
tampering (unauthorized removal or alteration of College documents, software, equipment, or
other academic-related materials, including other students work)
lying
working with others when assignments or exams require individual work
making unauthorized copies of copyrighted material
facilitating or tolerating the dishonesty of others

Academic dishonesty lowers scholastic quality and adversely affects those who will eventually depend
on the knowledge and integrity of our graduates. Failure to uphold the principles of academic integrity
negatively impacts the reputation of Touro, the value of each and every degree awarded by the
institution, and the future success of our graduates.
The Touro College and University System views violation of academic integrity with the utmost gravity.
Such violations will lead to appropriate sanctions, from failure in coursework up to and including
expulsion from the Touro College and University System. We commit ourselves to the shared vision of
academic excellence that can only flourish in a climate of integrity.
The complete Touro College and University System Academic Integrity Policy can be found online at
www.touro.edu/academic_integrity.
Safety Issues and Sexual Harassment
Any safety issues or harassment should be reported to the clinical coordinators immediately.
Housing
Housing is at the responsibility of the student