SURGERY 701

JUNIOR CLERKSHIP
ORIENTATION PACKET

NEPHTALI GOMEZ, MD SURGERY CLERKSHIP DIRECTOR

KRISTIAN BRAUN CLERKSHIP COORDINATOR
909-558-4982, EXT. 44982, KRBRAUN@LLU.EDU
KBRAUN@MY2WAY.COM PGR #6221
COLEMAN PAVILION SUITE 21122
LAST REVISED: JULY 2016
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GENERAL GOALS & OBJECTIVES FOR THE JUNIOR SURGERY COURSE
Through a balance of direct faculty observation and clinical activities, didactic presentation, directed review,
case based study and traditional and performance based testing; to impart to medical students the
knowledge, skills, values, attitudes and behaviors necessary for participation in the perioperative care of
patients in both ambulatory and hospital based settings, and for successful participation in sub-internships
and surgical electives during the senior year.

The most basic objectives for the course are:

1) To enable the junior students to demonstrate an adequate core knowledge base sufficient to pass
National Standardized Examinations and to allow them to participate in problem solving in the
clinical setting;

2) To provide opportunity for students to acquire basic clinical skills; to improve their ability in
medical interviewing and physical examination of surgical patients in a variety of clinical settings,
while demonstrating basic communication skills required for participation in the daily care of
patients;

3) To help students gain minimum competency in the performance of routine technical procedures
(as documented in the Surgery Department Skills Log);

4) To convey (in part by example) basic values and attitudes inherent in responsible professional
behavior and to foster in the students the ability to display and apply these principles in the
context of clinical decision making and patient care:

elements of clinical judgment,

the cooperative spirit and reliability required to successfully interact with colleagues and
contribute to patient care,
the concept of continuous learning and evidence-based study as a necessity for good patient
care and successful professional development,
an attitude of concern for each patient as a unique whole individual,
the establishment of trust between the physician, patient and family which requires respect for
the patient, manifest by a constant willingness to communicate and sensitivity to individual
differences in gender, ethnic background, social status and personal belief,
the importance of caring for patients in an ethical manner by striving always to understand
and to do that which is in the patients best interest and by holding the welfare of the patient in
the highest regard.

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 STUDENT RESPONSIBILITIES
1. REQUIRED TEXTS: The following are the required texts for the course:
Essentials of General Surgery, 5th Edition (Williams & Wilkins)
Essentials of Surgical Specialties, 3rd Edition
See book list attached / See Core Topic List

2. SELF-STUDY: Successful students will emphasize self-study. It is impossible to present completely in

didactic session or case-study format all the material which a student will be expected to know for
successful performance on the NBME subject exam or the USMLE-Step 2 Clinical Knowledge or
Clinical Skills Assessment. Students must read new material in a suitable text resource in order to
have a more complete overview of the subject; outlines or Q&A reviews are inadequate for most
students who have not built a cognitive knowledge base by reading throughout the course.

3 IN THE HOSPITAL OR CLINIC: IT is very important to recognize problems, know limitations, and ask for
help. The successful student in clinical surgery is most often "affable, available and aggressive". By all
means, ask questions and help your Faculty & Resident staff to "seize the teaching moment" when the
opportunity presents itself. Note: as a junior student you are given access to the IMPAX (X-Ray
system), PowerChart and LLEAP by the SOM/ Deans office. If you have trouble logging on
please contact the MC Help Desk at ext. 48889 for assistance! You will need access to this
program during your General Surgery rotation, specifically if you are rotating here at LLU. The
Surgery Education Office will provide access to a separate Surgery Residency Patient Lists
on the S drive. This will assist students in following Surgery Service patients with their Faculty
and Resident teams. Be sure you have completed a Computer Access Request Form
(provided at orientation).

4. BADGE ACTIVATION: At LLUMC, it is the students responsibility to verify that his/her badge works
properly for access to the O.R. If not, please see the O.R. Nurse Manager/ O.R. Administrative
Secretary in MC2329 @ x88020, Pager # 1009.

5. CALL FOR STUDENTS: Each clinical service/hospital determines its own call schedule for students.
Take advantage of this opportunity to learn about patient management and to practice clinical skills. It
is the student's responsibility to notify the chief resident/service chief of their
whereabouts/availability at all times. Unauthorized absence will result in required makeup time.
A total of 5 overnight (24 hr) periods of in-house on-call responsibility are required during the
General Surgery rotation (for the acute care service at LLUMC, 1-week, or approximately 5
shifts, of nighttime rotation work will suffice to meet the call requirement). You must record
your on-call dates in your log book.

SLEEPING ROOM FOR STUDENTS ON CALL AT LLUMC: - Students meeting in-house overnight
call requirements for Surgery (or Surgical Intensive Care Unit) rotations will find sleeping
accommodations in Room 8002-D. There will be a minimum of three beds available for students in
this room. Bathroom facilities and storage lockers are adjacent. The entry to this room is controlled
by a badge reader for security purposes.

Sleeping rooms are not to be used by students who are in-house by choice or on elective rotations.
Students are not to sleep in other areas of the hospital, particularly in public areas such as lounges,
lobbies, or the student lounge on A-Level. Medical students using these areas for this purpose will do
so at their own risk.

6. ACCESSING THE BEEPER SYSTEM WITHIN LLUMC:

In-House: Dial 1717 enter beeper enter phone extension
(you will hear a single tone after 1717; 3 tones after entering the pgr. #; 5 tones after the extension;
then the line will disconnect. If you receive a busy signal while beeping someone please hang up as
the system is busy.) Please be patient, as the beeper system is often busy and it may take 5 minutes
for a response. Externally: Dial 909-558-1717; enter beeper and #; enter phone number (you will hear
the same tones as stated above)

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7. FRIDAY CLASS SESSIONS/QUIZZES & LAB EXERCISES: (7:15am - 12pm, A-Level Amphitheater). These
sessions are required during the entire 10-week Junior Surgery course. Be alert for unavoidable
changes in the class schedule during the quarter. Attendance is Mandatory. You are excused from
in-house duties for Friday didactic sessions while on Surgery, however, you are required to report
back to your service immediately following lectures. Quizzes will be on Canvas and will count for
15% of the junior surgery grade. The highest 7 quiz scores will be counted. There will be no make-
up quizzes. A question bank with preferred answers is posted on the Canvas website to serve as a
study guide. There will be one sign-in opportunity during lecture hours. Failure to sign in by
7:30am will result in forfeit of your quiz points for that day.

Since student attendance during Friday morning is mandatory, important information

concerning upcoming exams, scheduled reviews and other announcements are conveyed at
this time. Students will be responsible for any announcements made during lecture hours.

8. INTEGRATED ETHICS COURSE (RELIGION 714): On one Friday during the course your attendance is
required at an Ethics Seminar conducted by the Department of Religion. Check your schedule
carefully for the course date, time and location.

9. SPECIALTY ROTATIONS:
A pass is achieved by student participation in all required clinical activities during the week as outlined
by the rotation/service, and completion of any skills requirements and any examinations administered.
Attendance at clinical assignments is not optional. Absences from activities in the clinical
schedule during the rotation may result in a failing grade. Students who fail specialty rotations will
be required to make-up the time on the appropriate service. The specialty weeks do not end Friday
at noon. Return, after lecture to your service for scheduled exams, work shifts or wrap up. Each
specialty rotation will provide a checkout sheet. This must be signed by the appropriate Faculty or
Administrative Assistant indicating that the student has passed each specialty rotation. It will be the
students responsibility to turn in a signed check-out sheet to each Specialty Rotation Office
following the completion of each specialty rotation (see attached directories).

10. STUDENT REQUIREMENTS ON GENERAL SURGERY ROTATION

MID-ROTATION PROGRESS REPORT, REQUIRED H&P, PRECEPTORS PROGRESS REPORT

(CLINICAL PERFORMANCE EVALUATION)
During the General Surgery portion of the course it is the students responsibility to work toward a mutually
convenient time to meet with their supervising attending faculty to discuss clinical performance before the
end of the third week of their General Surgery experience. A Mid-Rotation Progress Report must be
signed electronically by Attending Faculty in the One45 evaluation system (or a hard copy evaluation may
be submitted if an Attending Faculty requests one). Students must complete any Self-Assessment,
portion of the Mid-Rotation Report before sending it to Faculty via One45.

We require that each student review his/her Surgery Log Book and Skills List with Faculty at the time
of the Mid-Rotation Progress Report. This will enable supervising Faculty to assist in providing or
identifying clinical opportunities for students to meet requirements for skills and case encounters. Note:
Mid-Rotation Progress Reports are not required during specialty weeks.

Before completing their sixth week on a General Surgery Service, each student must review (with Faculty)
his/her Preceptor Progress Report (final evaluation). At least one completed Preceptor Progress
Report, (on One45 evaluation system) is required for completion of the course. Your grade for Clinical
Performance is determined using this online form. It is in your best interest that these evaluations be
complete and accurate. The student must complete the Self Assessment portion of the Preceptors
Progress Report before sending it to faculty via One45. It is the students responsibility to arrange a
meeting with supervising Faculty for feedback on their clinical performance. This must occur before
the end of the sixth week of General Surgery. Faculty and/or student absences must be anticipated.
Be sure that faculty have completed all parts of the form and have contributed in the Preceptors
general comments, section before you sign off electronically in One45.

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 Each student must turn in a completed grading sheet and related article for a History &
Physical they have performed to the Surgery Education Office. The grading sheet must be signed
by your Attending Faculty. The History & Physical itself must conform to the guidelines
found on the Canvas website. Please review the H&P instructions and guidelines. Your H&P is
not complete without an assessment, which describes the active surgical problem/diagnosis and
related differential, and a detailed management plan. You may annotate a copy of your H&P
before it is graded by Faculty. When presented to your Faculty supervisor for grading, your
History & Physical examination must have your patients name, medical record number, and your
signature. We recommend that you confidentially keep the name and chart number of the patient.
Remember that the H&P you performed is a portion of the patients medical record and
constitutes personal health information, which must be kept confidential. The history & physical
(or copy) must not leave the facility, which owns the medical records and in which the history &
physical was performed. After grading by Faculty the history & physical itself must either be
returned to the patients chart or destroyed (e.g. shredded). The Grading Sheet that you turn into
the Surgery Education Office must not bear any information linked to the patient. Your completed
grading sheet for the H&P will be due at the conclusion of lectures on the final Friday of
your General Surgery rotation (6th or 9th clinical week, depending on the order of your
rotation schedule).

Your H&P grading sheet must be accompanied by an article from the current surgery literature
which is related to the diagnosis of your patient. Your Faculty supervisor should review the
abstract of the article with you at the time he/she grades your H&P. Please sign your name on
the article and fasten it securely to your signed grading sheet.

11. SURGERY CLERKSHIP PATIENT LOGBOOK AND SKILLS LIST:

All students must complete all items on the Required Skills checklist and log a minimum
number of specified patient encounters to receive a Pass in the course. The skills checklist
also denotes your required attendance at specific clinical conferences such as Tumor Board,
Journal Club, and Suture Skills Lab. The logbook and the Canvas website contain specific
instructions for completion of the Required Skills List and for the Patient Encounter Entries. A
supervising M.D. must sign off each required skill. During the course, it is important that you see a
wide variety of surgery patients. A record of the clinical activity at each site will allow us to
adequately manage the course and to position an appropriate number of students at each clinical
site. You will be given a logbook at orientation. Lost books will be replaced at a fee of $5.00 each
(please see copy of surgery log book instructions attached).

Record all designated patient encounters in the Surgery Log area of your logbook, where they
are classified by surgical procedure (see instructions in logbook.) During your General Surgery
rotations (6 weeks total), it is expected that you will be individually responsible for daily care of
assigned inpatients. Please record those inpatients (assigned to you for 2 days or more), in the
designated are of your logbook. Before submitting your log book, please total all encounters
legibly in the designated areas and be certain all stated requirements are met. Please also record
your full name and General Surgery site/service assignment legibly on the front of the logbook.

Please also record the dates of your 24 hour periods of in-house on call responsibility (or dates of
your Acute Care night shifts), on the designated page.

12. ABSENCE: Any absence from a clinical assignment may require make-up time. If you are ill, and
must miss one day or more, you must be seen by approved Student Health Services and
submit a written off-work note. You must notify your service and the Surgery Education Office
immediately of any absence.

13. OBJECTIVE STRUCTURED CLINICAL EXAM: This exam will be given during the non-clinical (10th) week of
the course. You will receive information early during the rotation as to the type of simulated patient
problems you will encounter. Students who miss their appointment for the OSCE will receive a grade of
incomplete for Surgery and will be required to do special remediation and/or re-testing to make up this
deficiency. The OSCE accounts for 30% of your Junior Surgery grade. Students failing the OSCE
examination may be required to perform specific remediation during a directed study period. They
must then re-test and/or exhibit satisfactory performance on the school-wide OSCE exam given at year
end prior to receiving a final grade in Junior Surgery.

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14. NBME - SURGERY SUBJECT EXAM: This exam is taken at the end of your Surgery rotation as scheduled
by the Dean's office. This subject exam must be passed with a minimum score of 59. Failing
students must retake the exam and achieve the minimum passing score. Second failures result in a
grade of "F" and a repeat of the entire junior course. This exam accounts for 30% of your Junior
Surgery grade.

15. EXIT EVALUATION: An Exit Evaluation for your Junior Surgery course will be available via
Qualtrics. The program allows you to receive individual credit for completing your exit evaluation,
while keeping your responses confidential by combining them with other student responses in a
random sequence. Your comments about Faculty will also be confidentially collected for eventual
summation and feedback to individual Faculty members according to criteria established by the
Department of General Surgery. Your comments about Resident staff are summarized and
submitted to the Residency Program Director. In order to receive 1% grade credit you must
complete your evaluation on time. The exit evaluation is site (and service) specific. You will
have 1-week after the course ends to complete this exit evaluation for credit. After this deadline
no further responses to the exit evaluations may be submitted. Any student may request a paper
version of the exit evaluation; handwritten exit evaluations must be submitted in person to the
Surgery Education Office within the specified deadline.

The Deans office also requires that each student be offered a separate online evaluation on the
One45 system which includes evaluation of a Faculty member of your choice. The School of
Medicine will make this evaluation available. The School of Medicine will require you to do the
One45 assessment to receive your course credit.

16. GRADING SUMMARY:

30% - NBME Surgery Subject Exam (59 minimum passing score)
30% - Objective Structured Clinical Exam (OSCE)
19% - Clinical Performance Evaluation
15% - Lecture Quizzes (AM sign-in is required for quiz credit)
5% - Graded H&P w/article exercise
1%- Timely completion of the Surgery Education exit evaluations on Qualtrics (link will be
emailed to you)

Pass/Fail - Complete Patient Logbook and Clinical Skills List

Pass/Fail - Intra-Operative Evaluation of Medical Student (2 at Mid-Rotation and 2 at Final
Evaluation)
Pass/Completion on all specialty rotations

All the requirements listed must be completed before a final grade can be assigned.

Honors Grade to receive Honors in Surgery, the student must achieve an overall Final Grade
of 87% or higher.

High Pass to receive High Pass in Surgery, the student must achieve an overall Final Grade of
83% or higher.

*The student will receive an honors or high pass designation if, in addition:

There are no deficiencies in any area of Professionalism/Life Long Learning Skills

No adverse non-cognitive reports are received
All required work is completed and submitted by designated deadlines;
and attendance at required class sessions/conferences and clinical assignments is
satisfactory.

Pass Grade to receive a Pass in Surgery, the student must achieve:

An overall Final Grade of 65% or higher

An NBME subject exam score of 59 or higher
An OSCE exam score of 65% or higher
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17. SUMMARY OF REQUIREMENTS: In addition to end of clerkship examinations, completion of an
adequate logbook and required skills list, a signed Mid-Rotation Progress Report, a graded
H&P w/article completed during your General Surgery rotation, and the Preceptor Progress
Report. Completion of your specialty rotations is also required for a pass in the course.

The Clinical Performance Evaluation by Faculty, (aka Preceptor Progress Report), the OSCE and
the NBME exams are each independent Pass/Fail requirements for the course. Failure in any of
these will result in a grade of In-Progress and specific remediation will be required for a Pass.
Failure in 2 of these 3 will result in a transcript grade of Unsatisfactory and a repeat of the entire
course will be required.

PLEASE NOTE: The General Surgery Chairman or Clerkship Director may direct a student to repeat
a Surgery rotation due to an inadequate clinical performance evaluations, low test result, or neglect of
professional responsibilities outlined.

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 GENERAL SURGERY ROTATIONS
Kaiser Fontana Medical Center
9985 Sierra Avenue
Fontana, CA 92335
Jerry L. Pettis Memorial
Veterans Administration Hospital
Department of Surgery, Room 3F-09
Loma Linda University Medical Center
(Acute Care, General Surgery, Surg Onc)
11175 Campus Street, Suite 21111
Loma Linda, CA 92350
Riverside County Regional Medical Center
26520 Cactus Avenue, Room A2021
Moreno Valley, CA 92555
Coordinator: Carol Farrell
(909) 427-5626 or Carol.T.Farrell@kp.org
Rotation Director(s): Noel Victor, MD and Samir Johna, MD
Coordinator: Cornelious Bentley
(909) 583-6064 or LLU ext. 76064
Cornelious.Bentley@va.gov
Rotation Director: Derya Tagge, MD
Rotation Co-Director: Jason Chiriano, MD
Coordinator: Alana Symons
(909) 558-4286, ext. 44286 or asymons@llu.edu
Dr. Karen OBosky, Student Director (Acute Care), pgr 4689
Dr. Daniel Srikureja, Student Director (Gen Surg), pgr 4389
Dr. Naveen Solomon, Student Director (Surg Onc), pgr 4248
Coordinator: Tinesha Charles
(909) 558-4619, ext. 44619 or tcharles@llu.edu
Dr. Baerg, Student Director (Peds Surg), pgr 4584
Coordinator: Janelle Munoz
(951) 486-4175, janelle.munoz@ruhealth.org
Rotation Directors: Aaron Depew, MD and Afshin Molkara, MD
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 SPECIALTY WEEK ROTATIONS
Orientation Instructions: Refer to Medical Student Rotation Schedule for Anesthesia &
Selective Weeks (left column) to learn where/when to pick up orientation materials.

Anesthesiology Coordinator: Sheila Risley

Rotation Director: Bryan Halverson, MD, Beeper #4194
Room MC-2539, extension 44476, srisley@llu.edu

Cardiothoracic Surgery Coordinator: Maria Riley

Rotation Director: Anees Razzouk, MD, Beeper #4189
Room CP-21123, extension 44354, mriley@llu.edu

Head & Neck Surgery (ENT) Coordinator: Cynthia Greber

Rotation Director: Helen Xu, MD, Beeper #4641
Room MC-2584, extension 88558, cgreber@llu.edu

Neurosurgery Coordinator: Xiomara Pineda / Erika Matthews

Rotation Director: Kenneth De Los Reyes, MD, Beeper #
Room MC-2562B
Xiomara extension 44726, xpineda@llu.edu
Erika extension 88723, ematthews@llu.edu

Ophthalmology Coordinator: Jason Polanco

Rotation Director: Ernest Zane, MD, Beeper #4350
Room FMO Suite 1800, extension 22076, jpolanco@llu.edu

Orthopedic Surgery Coordinator: Mary Kolb

Rotation Director: Wesley Phipatanakul, MD, Beeper #4602
East Campus Ambulatory Services Bldg,
11406 Loma Linda Dr., Suite 214A, extension 62709, mkolb@llu.edu

Pediatric Surgery Coordinator: Tinesha Charles

Rotation Director: Edward Tagge, MD, Beeper #4658
Room CP-21111, extension 44619, tcharles@llu.edu

Plastic & Reconstructive Coordinator: Karina Cantuna

Surgery Rotation Director: Hahns Kim, MD, Beeper #4859
Room CP-21126, extension 88085, kcantuna@llu.edu

Transplant Surgery Coordinator: Jamie Adair

Rotation Director: Philip Wai, MD, Beeper #4314
Room LL-PC, extension 33650, jadair@llu.edu

Urology Coordinator: Terri Chaffin

Rotation Director: Duane Baldwin, MD, Beeper #4977
Room A-562, extension 42696, tchaffin@llu.edu

Vascular Surgery Coordinator: Molly Kurth

Rotation Director: Ahmed M. Abou-Zamzam, MD, Beeper #4197
Room CP-21123, extension 88648, mkurth@llu.edu

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 SURGICAL TEXTS
REQUIRED COMPREHENSIVE TEXTS:

Essentials of General Surgery, 5th edition by Lawrence (Williams & Wilkins) ISBN 0781784956
Essentials of Surgical Specialties, 3rd edition ISBN 0781775019

ALTERNATIVES:

Current Surgical Diagnosis and Treatment, 13th edition by Way (Lange, 2009)
ISBN: 9780071635158

SUPPLEMENTAL TEXTS OF INTEREST

The Washington Manual of Critical Care, 2nd edition, edited by Marin H. Kollef, et al, 2012 edition.
Wolters Kluwer Health / Lippincott Williams & Wilkins -- ISBN 9781451110227

Copes Early Diagnosis of the Acute Abdomen, Edited by William Silen, MD, 22nd Edition,
Oxford University Press 2010 -- ISBN 0199730458

Cancer Staging Handbook, American Joint Commission on Cancer, 7th Edition,

Springer, New York 2010 ISBN 978-0-387-88442-4

Surgical Anatomy and Technique (A Pocket Manual), 4th edition, Springer, New York, 2014 - ISBN
978-1-4614-8562-9, e-ISBN 978-1-4614-8563-6

REFERENCE TEXTS:

Principles of Surgery, 9th edition by Schwartz. McGraw-Hill 2009 -- ISBN 9780071547697

Textbook of Surgery, 18th edition by Sabiston. Elsevier Health Sciences, 2009--

ISBN 9781416036753

ELECTRONIC RESOURCES: http://www.llu.edu/llu.library/

Del Webb/University Libraries online via Canvas or UMC network includes:

The STAT-REF! - Database (with comprehensive search engine) which incorporates:

ACS Surgery Principles & Practice (American College of Surgeons)

Schwartz - 9th Edition

Up To Date

Advanced Medical Ethics - Religion714

Medical Ethics & The Faith Factor, etc., William B Eerdmans Pub Co. ISBN 9780802864048

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 SCHEDULED VACATION & TIME OFF
All students are given time off for Christmas break. Any other holidays are given at the discretion
of the Chief of Service you are assigned to.

For any time off from a Surgery rotation the request must be submitted at least 2 weeks prior
to the date(s) you wish to take off (unless in the case of a dire emergency). Days off must be
made up, as arranged with the Clerkship Coordinator. Make up time cannot be scheduled
during another required School of Medicine course (verification of time made up is required). All
time off requests must be routed through the Surgery Student Coordinator (CP-21122). We will
initial the time off request, (to assure the Faculty physician that the student has the time off
approved), and will then forward the request to the appropriate Faculty or department for
approval, and upon approval will send original to School of Medicine. The scheduled dates for
make-up time must be included on the request before it is submitted.

Time off for illness: You must notify the Surgery Education Office if you are ill; there is a
24-hour message phone for this purpose: (909) 558-4982, ext. 44982, or page the student
coordinator at #6221 (kbraun@my2way.com). You should also notify your Service Chief and
Senior Resident, as well as the coordinator for the department you are on service with. You are
responsible for notifying your service whether you are on General Surgery or a specialty week.

Significant time lost from clinical or ambulatory rotations due to illness will require make up. If
you miss more than one day, you will need to go to Student Health Services and obtain an
off-work order.

STANDARDS FOR APPEARANCE & APPAREL

Students are expected to maintain an appearance at all times that is consistent with the highest
professional standards and that project to the public an image of cleanliness, competence, and
professionalism. The image should be modest and consistent with the mission and philosophy of Loma
Linda University.

Personal Grooming: Good taste indicates that haircuts, hairstyles, and personal grooming be neat and
conservative rather than ostentatious. Grooming and style should also be practical so as to enable ones
duties to be performed without embarrassment, inconvenience, or threat to safety. Specifically: (1) Hair
must be clean and neat, avoiding radical styles. Pony tails or long hairstyles are not permitted for
men. (2) Mustaches and beards, if worn, must be clean, neat, and trimmed. (3) Cosmetics and perfumes
should be inconspicuous. (4) Loma Linda University discourages the wearing of jewelry. If a woman
chooses to wear earrings, they should not drop below the bottom of the earlobes and must be limited to
one per ear. Earrings are not permitted for men. Nose rings, lip rings, or other visible forms of body
piercing are not permitted for men or women. (5) Fingernails should be maintained in a professional
manner, be closely trimmed, and should not interfere with patient care or professional duties. Nail polish,
if worn, should be subdued in color.

Clean, short, white coats with approved name tags are to be worn at all times for clinical appointments,
including during assignments at affiliated hospitals and while on electives. Men are to wear neckties and
neatly pressed slacks (not jeans). Women should wear professional appearing skirts, dresses, or slacks.
Some clinical sites may have dress requirements that are more specific than those listed here. Modest
casual wear is appropriate on campus and in class. In settings where shorts are acceptable, they must be
neat and at least mid-thigh in length. Sloppy clothing, tank tops, tight-fitting shorts, clothing that is torn or
frayed, bare midriffs, miniskirts, and skirts with deep slits are not appropriate in any of the clinical facilities,
classrooms, library, or cafeteria. Words, pictures, and/or symbols displayed on clothing should be
consistent with an Adventist Christian institution and sensitive to a diverse student population. Shoes are
considered standard apparel. Flip-flops or sandals are not appropriate in any clinical facility. Students
must wear a name tag and ID badge at all times when at LLUMC or its affiliates. Reference - Loma Linda
University, School of Medicine, Student Handbook 2012-2013, Standards for Appearance and
Apparel, pg 162.

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SURGERY EDUCATION ADDENDUM:

1. Each hospital has scrub attire rules for OR which must be followed; in general, all hair must
be covered in the OR

2. Scrubs are allowed only while in the OR, on-call or post-call.

3. Short, clean, well-groomed beards are acceptable.

4. Tennis shoes are only permitted in the OR; not on Units or in Clinics.

5. No acrylic nails!

6. Students violating the dress code will be asked by attending physicians or senior resident
staff to leave and return appropriately attired. Time missed from clinical services for this reason
must be made up. Such incidents will result in notation on the Deans Clinical Performance
Evaluation or in a Non-Cognitive report the Deans office.

MEDICAL ETHICS (RELIGION 714)

A School of Medicine course: Advanced Medical Ethics (Religion 714) has been integrated
into the School of Medicine junior year curriculum. There will be one seminar scheduled for you
here at Loma Linda Campus during the course, generally following Friday didactic lectures.
Your attendance and participation is required. Please consult your schedule. Your clinical
rotation directors will be aware of this time obligation.

The surgical patient, like any other, has a diagnosis that must be discovered and a
specific treatment that can correct the problem. With the wonders of modern medical
technology, we have many tools to assist us in reaching the correct diagnosis and in
administering treatment to correct the problem we diagnose. Any patient will be found in
a set of circumstances, which may either help or worsen their medical situation. These
factors cover a wide spectrum, and can include such things as healthy or unhealthy life
habits such as diet, smoking, drinking, choosing to ride a motorcycle without a helmet,
and gang membership. There are other types of factors as well, such as family support,
or lack thereof, and the state of an individuals spiritual health. When the time is taken to
learn about these factors from the patient and they are taken into account in developing
a care plan for that patient; this is what we consider to be whole person care.

While making the correct diagnosis and providing the appropriate surgical treatment
could be considered a medical success, expanding that to take note of and treat factors
in the whole person realm can potentially lay the ground work for prevention of future
occurrences. Thus, whole person care is more than just concept; it should be a
foundation of every responsible physicians practice in surgery or any other specialty.

Steven Herber, MD

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 LOG BOOK INSTRUCTIONS

Completion of the Surgery Clerkship Log Book is mandatory. Any student who does not submit the
Log before the end of the rotation or who has an inadequate number of patient entries or an
incomplete skills list will receive a grade of In-Progress in Surgery until the problem is corrected
and the complete Logbook is submitted. Sloppy, illegible, and/or incomplete entries are not acceptable.
If your handwriting is poor, print legibly. Remember that if your log book contains confidential patient
information, it must be guarded against inadvertent or inappropriate disclosure.

INSTRUCTIONS FOR THE SKILLS LIST

All listed skills must be completed during the Surgery Clerkship and documented with a resident or
Faculty signature. Entries must include the rotation and facility location where the skill requirement was
first met. You may perform these essential requirements at any opportunity, on any rotation or service
during the clerkship. 100 percent completion of this list is required.

Following the skills list is a page for you to record the dates of your in-house, 24-hr. periods of on-call
responsibility. You must serve a total of 5 call dates during the General Surgery rotation to pass the
course. LLUMC students will record dates of their 1-week Acute Care Service night shifts.

INSTRUCTIONS FOR SURGERY LOG ENTRIES

For the Surgery clerkship, important patient encounters will be classified according to the type of operative
surgical procedure performed for the patient and by the students role in the encounter. Each category of
operative procedure includes many different diagnoses. (The occasional encounter with a patient not
receiving a significant operative procedure during an admission can be classified by diagnosis and
according to the general problem area represented by each surgical procedure. For example, an H&P
done for a patient admitted for critical care management of pancreatitis, but not having an operative
procedure, could be listed as a new patient evaluation under abdominal surgery/pancreas). Please
familiarize your self with each category in the surgery log. If you have questions about where to place a
particular patient encounter, we are always happy to help.

SURGERY LOG entries should be made only for the following types of patient encounters:

1. All patients having surgery that you have scrubbed in on. (Operating room observation is not
included with the exception of Ophthalmology).

2. All new patient evaluations such as any history & physical examination for hospital admission or pre-
surgery (this includes complete H&P, short form H&P or admitting interval notes) and any new patient
evaluation performed as a full consultation. New patient evaluations may occur in an inpatient setting,
outpatient clinic, or emergency department. (Outpatient follow up visits are not included).

3. Patients for whom you are given individual responsibility for daily inpatient care, for at least 2
days or more. Note that only one entry per patient would be made in the appropriate surgical category for
all days of inpatient care during a single admission.

For each patient encounter to be entered in the surgery log, simply place a tick mark in the appropriate
category under the column that applies. It is possible for example, that you would scrub in on surgery for
a patient for whom you have also done a new patient evaluation or workup, or have responsibility for
inpatient daily care for a patient that you have scrubbed on or worked up as well. In these cases, you will
place a tick mark in each column that applies, next to the appropriate type of procedure for that patient,
(that is 1 patient having 1 surgical procedure could count as 3 encounters, with the student [you] filling a
different role in each).

As you can see, there are spaces in the log book for totals in each surgical category horizontally on the
right margin, and totals for each page in each type of encounter at the end of the vertical columns.

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Please Note:

The Surgery Education office has determined that valid encounters with certain types of patients are
essential for all students in the clerkship. These requirements are clearly listed in the surgery log. They
include at least 3 encounters in the Abdominal Surgery category, at least 3 encounters within
surgery of the Alimentary Tract, a minimum of 4 encounters from any areas of specialty interest,
and at least 1 encounter in a trauma case. Each requirement must be met to pass the course.

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