2012 SURGERY Proposal for Changes Third Year Surgery Clerkship Third Year Surgery Clerkship.

2012 SURGERY2012 SURGERY

Proposal for Changes Proposal for Changes

Third Year Surgery ClerkshipThird Year Surgery Clerkship

Surgery ClerkshipSurgery Clerkship

1987 Dr. Michael Zinner arrives as new 1987 Dr. Michael Zinner arrives as new Chairman of SurgeryChairman of Surgery

1992 Dr. Edward Livingston appointed 1992 Dr. Edward Livingston appointed Clerkship Director ,Residency DirectorClerkship Director ,Residency Director

1993 Surgery Clerkship 1993 Surgery Clerkship Partitioned:Partitioned: Surgery I (6 weeks of 3rd Year Surgery) andSurgery I (6 weeks of 3rd Year Surgery) and Surgery II (6 weeks of 4Surgery II (6 weeks of 4thth Yr Surgery) Yr Surgery)

1993 Partition1993 Partition

1993-4 New Surgery Clerkship implemented1993-4 New Surgery Clerkship implemented

Reaction from students and faculty was Reaction from students and faculty was overwhelminglyoverwhelmingly negativenegative

Multiple Problems: Multiple Problems: with continuity of curriculumwith continuity of curriculum students not completing required course in time students not completing required course in time

for graduation for graduation students had difficulty with separation of contentstudents had difficulty with separation of content

1994 Surgery1994 Surgery

1994 1994 Dr. Carmak Holmes, new Chairman of Surgery, Dr. Carmak Holmes, new Chairman of Surgery,

Dr. Ronald Tompkins, Vice-Chair for Education, Dr. Ronald Tompkins, Vice-Chair for Education, Dr. Hugh Gelabert, Clerkship DirectorDr. Hugh Gelabert, Clerkship Director

Tried to make the partitioned clerkship work – Tried to make the partitioned clerkship work – to no availto no avail

1995 Petitioned MEC to allow Surgery 1995 Petitioned MEC to allow Surgery Clerkship to revert to continuous 12 weeksClerkship to revert to continuous 12 weeks

1994-1995 MEC1994-1995 MEC

MEC - period of curricular reformMEC - period of curricular reform Introduction of PBLIntroduction of PBL Introduction of CPXIntroduction of CPX Introduction of standardized patientsIntroduction of standardized patients Initiatives by California Legislature and Initiatives by California Legislature and

National Political impetus to National Political impetus to prioritize prioritize primary and ambulatory careprimary and ambulatory care

1995 MEC Directives1995 MEC Directives

1995 MEC Directive to strengthen 1995 MEC Directive to strengthen physical diagnosisphysical diagnosis

Early CPX data indicated UCLA students Early CPX data indicated UCLA students fared poorly in several areasfared poorly in several areas

Surgery Department TaskedSurgery Department Tasked with teaching with teaching several areas of physical exam: abdomen, several areas of physical exam: abdomen, vascular, ENT, orthopedic, & GU examsvascular, ENT, orthopedic, & GU exams

1995 Surgery Proposal1995 Surgery Proposal

1995 Surgery Proposal:1995 Surgery Proposal:

Combined Ambulatory Surgery and In-Patient Combined Ambulatory Surgery and In-Patient Surgery Clerkship: 6 weeks & 6 weeks to run Surgery Clerkship: 6 weeks & 6 weeks to run consecutively as a 12 week blockconsecutively as a 12 week block

Introduction to Surgery Week: multidisciplinary Introduction to Surgery Week: multidisciplinary lectures and moduleslectures and modules

Emphasis on tasked areas of physical Emphasis on tasked areas of physical diagnosis: Specific lectures, PE Modulesdiagnosis: Specific lectures, PE Modules

1995 Surgery Proposal1995 Surgery Proposal

1995 Surgery Proposal:1995 Surgery Proposal:

Revision of Surgery clerkship Curriculum to Revision of Surgery clerkship Curriculum to emphasize material common to all practitioners emphasize material common to all practitioners (with regard to primary care directives)(with regard to primary care directives)

Integration of PBL into curriculumIntegration of PBL into curriculum

Integration of Doctoring into curriculumIntegration of Doctoring into curriculum

Integration of Radiology into curriculumIntegration of Radiology into curriculum

1995 Surgery Proposal1995 Surgery Proposal

1995 Surgery Proposal1995 Surgery Proposal

Ambulatory Clerkship – 6 weeks durationAmbulatory Clerkship – 6 weeks duration

Elements: ENT, Orthopedics, Urology (per Elements: ENT, Orthopedics, Urology (per MEC tasking), Anesthesia, Ophthalmology, MEC tasking), Anesthesia, Ophthalmology, Plastic Surgery or Neurosurgery included Plastic Surgery or Neurosurgery included in 6 rotations, each 1-week longin 6 rotations, each 1-week long

1995 Surgery Proposal1995 Surgery Proposal

1995 Surgery Proposal1995 Surgery Proposal General Surgery Clerkship – 6 week General Surgery Clerkship – 6 week

durationduration

Elements:Elements:General Surgery rotation balancing General Surgery rotation balancing County / VA experience with Tertiary County / VA experience with Tertiary Hospital experienceHospital experience

2 rotations, each 3 weeks long. 2 rotations, each 3 weeks long.

1995 Surgery Proposal1995 Surgery Proposal

1995 Surgery Proposal:1995 Surgery Proposal: Additional Departmental InitiativesAdditional Departmental Initiatives

Residents as Educators programResidents as Educators program Faculty DevelopmentFaculty Development Surgery Education Departmental RetreatsSurgery Education Departmental Retreats Surgical Education Grand Rounds, Invited Surgical Education Grand Rounds, Invited

Lecturers Lecturers

1996 Surgery1996 Surgery

1995-6 Surgery Clerkship reformed 1995-6 Surgery Clerkship reformed and implementedand implemented Overall reception very goodOverall reception very good Recognition for innovation and Recognition for innovation and

successful implementationsuccessful implementation

20042004

Dr. Ronald Busuttil, Dr. Ronald Busuttil, ChairmanChairman Surgery Department Surgery Department

Dr. Jonathan Hiatt, Dr. Jonathan Hiatt, Vice Vice Chair for Surgery EducationChair for Surgery Education

Dr. Hugh Gelabert, Clerkship Director Dr. Hugh Gelabert, Clerkship Director Review of Clerkship and CurriculumReview of Clerkship and Curriculum Review of Surgery ResidencyReview of Surgery Residency

UCLA SOMUCLA SOM

1996-2010 1996-2010

PDA initiativePDA initiative

Development of Digital educationDevelopment of Digital education

Centralization of QI data: Student Centralization of QI data: Student SurveysSurveys

AngelAngel

Educational CompetenciesEducational Competencies

UCLA SOMUCLA SOM

2006-20092006-2009 Implemented new curriculum for 1Implemented new curriculum for 1stst

and 2and 2ndnd years years Implemented Colleges in 4Implemented Colleges in 4thth year year Task force to review 3Task force to review 3rdrd year – Dr year – Dr

HiattHiatt

2010-12 Surgery Issues2010-12 Surgery Issues

Clerkship ProblemsClerkship Problems Evaluation and feedback cycle too longEvaluation and feedback cycle too long One week rotations are too shortOne week rotations are too short Difficulty integrating to clinical teamsDifficulty integrating to clinical teams Students seen as ‘tourists’Students seen as ‘tourists’ Difficult to evaluate or provide constructive Difficult to evaluate or provide constructive

feedbackfeedback Some rotations are removed from central Some rotations are removed from central

objectives of teaching core Surgery Curriculumobjectives of teaching core Surgery Curriculum

2012 Surgery Proposal2012 Surgery Proposal Surgery Clerkship CommitteeSurgery Clerkship Committee

Dean’s Office: Deans Wilkerson, Parker, Hiatt, Carl Stevens, Sara Dean’s Office: Deans Wilkerson, Parker, Hiatt, Carl Stevens, Sara KimKim

Anesthesia: Mitchell LinAnesthesia: Mitchell Lin ENT: Vishad NabiliENT: Vishad Nabili General Surgery: Hugh Gelabert, Chris DeVirgilio, David Chen, General Surgery: Hugh Gelabert, Chris DeVirgilio, David Chen,

Bryne Lee, Jessica O’Connell, Mark Sawicki, Shirin Towfigh, Darin Bryne Lee, Jessica O’Connell, Mark Sawicki, Shirin Towfigh, Darin Saltzman, Nova Foster Saltzman, Nova Foster

Neurosurgery: Isaac YangNeurosurgery: Isaac Yang Ophthalmology: Gary Holland, JoAnn GiaconiOphthalmology: Gary Holland, JoAnn Giaconi Orthopedics: Jeff Eckardt, Sharon HameOrthopedics: Jeff Eckardt, Sharon Hame Plastic Surgery: Charles TsengPlastic Surgery: Charles Tseng Transplantation: Fady KaldasTransplantation: Fady Kaldas Urology: Larissa RodriguezUrology: Larissa Rodriguez Vascular: Steven FarleyVascular: Steven Farley

2012 Surgery Proposal2012 Surgery Proposal Reform of Surgery ClerkshipReform of Surgery Clerkship

Consolidate SubspecialtiesConsolidate Subspecialties to allow more time with to allow more time with each rotationeach rotation

Minimum durationMinimum duration 2 weeks, oriented towards 2 weeks, oriented towards integrated participation in servicesintegrated participation in services

RequireRequire participation in 2 of: Ortho, GU, ENT participation in 2 of: Ortho, GU, ENT

Allow choiceAllow choice of 1 of Ophthalmology, Neurosurgery, of 1 of Ophthalmology, Neurosurgery, Transplant, Cardiac, Thoracic, Plastic, Anesthesia, Transplant, Cardiac, Thoracic, Plastic, Anesthesia, Ortho, GU, ENTOrtho, GU, ENT

2012 Surgery Proposal2012 Surgery Proposal

Revise Curriculum Revise Curriculum Emphasis on competencies in educationEmphasis on competencies in education

Competency based reviews and exercises Competency based reviews and exercises (Case Log, Mini-CEX, Practical Exam)(Case Log, Mini-CEX, Practical Exam)

Quality Initiatives: student oriented Quality Initiatives: student oriented analysis of cases and outcomesanalysis of cases and outcomes

2012 Surgery Proposal2012 Surgery Proposal Revise Evaluation and Feedback Revise Evaluation and Feedback

Continue mid-clerkship evaluation and Continue mid-clerkship evaluation and feedback to be given in person to students feedback to be given in person to students

Require ESS evaluations from specialty Require ESS evaluations from specialty rotationsrotations

Continue the “Three Line” evaluationContinue the “Three Line” evaluation Overall assessment Overall assessment Constructive criticism Constructive criticism Confidential comments Confidential comments

2012 Surgery Proposal2012 Surgery Proposal

CurrentCurrent 6 week Gen Surg6 week Gen Surg 6 week Ambulatory6 week Ambulatory Amb: 1 week long Amb: 1 week long

rotationsrotations 5 Required 5 Required

SubspecialtiesSubspecialties Random Random

AssignmentAssignment

ProposedProposed 6 week Gen Surg6 week Gen Surg 6 week Ambulatory6 week Ambulatory Amb: 2 week long Amb: 2 week long

rotationsrotations 2 Required 2 Required

subspecialties, 1 choicesubspecialties, 1 choice Student selection of Student selection of

assignments from 9 assignments from 9 choiceschoices

Incorporation into teams Incorporation into teams (inpatient and (inpatient and ambulatory) ambulatory)

2012 Surgery Proposal2012 Surgery Proposal

Current Current ESS Evaluation at end of ESS Evaluation at end of

clerkshipclerkship

Separated constructive, Separated constructive, supportive, and supportive, and confidential feedbackconfidential feedback

Traditional curriculumTraditional curriculum

Departmental M&M Departmental M&M sessionssessions

ProposedProposed Mid-clerkship feedback, Mid-clerkship feedback,

ESS EvaluationESS Evaluation Separated constructive, Separated constructive,

supportive, and supportive, and confidential feedbackconfidential feedback

Competency based Competency based curriculum (Case Log, curriculum (Case Log, CEX) CEX)

Content: Departmental Content: Departmental M&M sessions, Didactics, M&M sessions, Didactics, and Online Resourcesand Online Resources

2012 Surgery Proposal2012 Surgery Proposal

Anticipated BenefitsAnticipated Benefits Improved student Improved student integration to servicesintegration to services Improved student Improved student participationparticipation Improved student Improved student evaluationevaluation Improved Improved curriculumcurriculum (competencies, QI) (competencies, QI)

Overall: Overall: Improved Educational Improved Educational ExperienceExperience