M2 Clerkship

A second-year medical student clerkship gives you the surgical knowledge and clinical skills you'll need as a physician, regardless of your ultimate choice in specialties. 

"Here at the University of Michigan, our goal is to be leaders in research, clinical care, and education."

Dr. Reddy, Clerkship Director

Overview

The Department of Surgery is honored to welcome incoming M2 students to their clerkship. We are committed to training the next generation of leaders in the field of academic surgery, and the M2 clerkship is one of the beginning steps in a surgeon's career.

The clerkship consists of twelve weeks of a 4-week Applied Sciences course, and two 4-week blocks of Clinical Surgery services. This includes one block on General Surgery services (Veterans Hospital, Surgery Oncology, Colorectal, Acute Care, Gastrointentestinal, Endocrine/Minimally Invasive and/or Transplant Surgery) and a second block on a Surgery Specialty service (Vascular, Thoracic, Pediatric, Plastic, or Urology Surgery). The 4-week Applied Sciences course has four 1-week blocks of Anesthesiology, Anatomy, Pathology, and Radiology. 

Learning Objectives

Clinical Knowledge

  • 1. Given a patient with one or more common surgical presenting problems the student should be able to generate a working differential diagnostic list, outline the appropriate steps to confirm or eliminate the various possibilities, and be familiar with management options.
  • 2. Core presenting problems include:
    • A. Acute and chronic abdominal pain
    • B. Breast mass
    • C. Claudication and cold pulseless extremity
    • D. GI bleeding
    • E. Oliguria/anuria
    • F. Neck mass
    • G. Jaundice
    • H. Shock, Trauma, and Burns
    • I. TIA and carotid stenosis
    • J. Hernia
    • K. Post-operative fever
  • 3. Given a patient with one of the following diagnoses, the student will be able to describe classical evidence (historical, physical, laboratory and/or radiologic) to support such a diagnosis:
    • A. Acute appendicitis
    • B. Esophageal hiatal hernia, reflux esophagitis, esophageal neoplasm, dysphagia, achalasia
    • C. Gastric neoplasm
    • D. Peptic ulcer disease
    • E. Inflammatory bowel disease (ulcerative colitis. Crohn’s disease)
    • F. Mechanical bowel obstruction/ileus – different characteristics of a proximal vs. distal bowel
    • G. Diverticular disease of the colon
    • H. Colon neoplasm – characteristics of a right-sided lesion vs. a left-sided lesion
    • I. Hemorrhoids, anal fistulae and fissures
    • J. Hernia (inguinal, femoral, incisional, others)
    • K. Cholecystitis/Biliary colic
    • L. Pancreatitis
    • M. Pancreatic carcinoma
    • N. Bleeding esophageal varices
    • O. Splenic rupture
    • P. Thyroid carcinoma
    • Q. Hyperparathyroidism
    • R. Pheochromocytoma/other biologically active adrenal tumors
    • S. Carcinoma of the breast
    • T. Soft tissue sarcomas
    • U. Malignant melanoma
    • V. Peripheral arterial occlusive disease and extracranial cerebrovascular disease
    • W. Chronic venous insufficiency/varicose veins
    • X. Acute deep venous thrombosis and pulmonary embolism
    • Y. Anesthesia physiology
    • Z. Radiology exams
    • AA. Pathology overview

Skills

The student will demonstrate competence in:

  • 1. Communication skills:
    • A. Interacting effectively and sensitively with patients and health care teams in verbal and written presentations.
    • B. Recognize the important role of patient education in prevention/treatment of disease.
    • C. Verbal Presentations: Organize a case presentation to accurately reflect the reason for the evaluation, the chronology of the history, the details of physical findings, the differential diagnosis and the suggested initial evaluation. Precisely description of physical findings. Justify thought process that led to diagnostic and therapeutic plan.
    • D. Written Documentation: Document the independent clinical thinking of the student. When using templates, or their own prior documentation, students should carefully adjust the note to reflect newly completed work and to ensure the note is a useful addition to the medical record.
  • 2. History Taking: Collecting complete and accurate information and focusing appropriately.
  • 3. Physical Exams: Exam of the surgical patient. Specific expertise and focus on the abdominal and vascular examination. Clear and precise description of wounds (surgical and traumatic)
  • 4. Clinical Problem Solving: Using data from history, physical, labs and studies to define problems, develop a differential diagnosis, and identify associated risks.
  • 5. Clinical Decision Making: Incorporating patient data with patient needs and desires when formulating diagnostic and therapeutic plans.
  • 6. Self-Education: Recognizing knowledge deficits and learning needs through a reflective self-assessment process, plan or seek assistance in remediation of knowledge deficits, develop key critical thinking and problem-solving skills. Seek feedback.
  • 7. Peer Assessments- for simulation
  • 8. Procedures: The student shall be able to list the indications, contraindication, and complications of the following:
    • A. Upper and lower endoscopy
    • B. Internal jugular and subclavian central venous catheter
    • C. Radial artery puncture and catheterization
    • D. Mammography of the breast
    • E. CT scan
    • F. Diagnostic angiogram
    • G. MRI
  • 9. The student shall be able to list the indications, contraindication, and perform the following basic procedures:
    • A. Perform venipuncture and establish an intravenous line
    • B. Perform an arterial puncture or place an arterial line
    • C. Insert a nasogastric tube
    • D. Remove a nasogastric tube
    • E. Insert a Foley catheter
    • F. Remove a Foley catheter
    • G. Demonstrate appropriate technique in packing an open wound.
    • H. Close a wound using a subcuticular stitch
    • I. Remove or insertion of a surgical drain
    • J. Irrigate or debride a contaminated or infected wound.
    • K. Using aseptic technique, prepare body surface for a surgical incision.
    • L. Control bleeding from a deep soft tissue laceration (apply pressure).
    • M. Removal of sutures or surgical staples

Professionalism

The student will be expected to:

  • Demonstrate compassion, empathy and respect toward patients, including respect for the patient’s modesty, privacy and confidentiality.
  • Demonstrate communication skills with patients and families that convey respect, integrity, flexibility, sensitivity and compassion.
  • Demonstrate respect for patient and family attitudes, behaviors and lifestyles, paying particular attention to cultural, ethnic and socioeconomic influences to include actively seeking to elicit and incorporate the patient’s parent’s and family’s attitudes into the health care plan, showing flexibility to meet the needs of the patient and family.
  • Function as an effective member of the health care team, demonstrating collegiality and respect for all members of the health care team.
  • Demonstrate a positive attitude and regard for education by demonstrating intellectual curiosity, initiative, honesty, responsibility, dedication to being prepared, maturity in soliciting, accepting and acting on feedback, flexibility when differences of opinion arise and reliability.
  • Identify and explore personal strengths, weaknesses and goals.

Course Requirements

The clerkship will include patient care work-ups on a minimum 30 inpatient/outpatient cases.

Core conditions to be seen or reviewed:

  • Abdominal Pain
  • Mass/Tumor
  • Atherosclerotic Disease: Peripheral Vascular Disease or Carotid Diagnosis
  • Liver Disease: Abnormal LFTs
  • Perioperative Care: Postop Complications
  • Substance-related Disorders: Post-op pain manager
  • Endocrine disorders
  • GI Symptom
  • Bleeding and Thrombosis
  • Hernia

Methods of Assessment

Our methods of assessment include:

  • Observation of clinical performance by faculty and house officers.
  • Standardized written examination administered at the end of the rotation.
  • Oral examination administered by surgery faculty at the end of the rotation.
  • Administrative Grade (WISE-MD, CLTP, Procedures, and Direct Observation) and Applied Sciences.

Evaluation & Grading

  • 60% Clinical
    • 30% Each Clinical Surgery Month
    • Satisfactory/Fail for 4 week Applied Sciences
  • 25% Shelf
  • 10% Oral exam
  • 5% Administrative

Course Structure

The Surgery and Applied Sciences is a three-month clerkship. All students complete two different surgery rotations, each being one month. Students also complete one month of Applied Sciences, which consists of one week of Anatomy, Anesthesia, Pathology, Radiology and a Simulation Lab curriculum across the entire three months.

Pedagogy

The primary goal of the Surgery Clerkship for each second year student is to develop a systematic approach to clinical problem-solving, the recognition of dealing with acute medical issues, and a basic understanding of surgical diseases.  Objectives include an understanding of the pathophysiologic basis of diseases, the ability to perform an accurate history and physical exam, and the ability to understand the role of surgery and procedures in disease management.  Objectives also ask students to learn to perform basic procedures (suturing, Foley catheter placement, etc.) through a combination of simulation and clinical practice.  Objectives include the ability to accurately and efficiently present a patient’s history in both written and verbal format and to understand the operating room learning environment.  Objectives ask that the student recognize personal limitations and develop the skills necessary for lifelong learning and the ability to interact with all members of the healthcare team.

Course & Program Evaluation Plan

  • Clerkship evaluations by students
  • Annual SWOT report
  • Annual Review by CTOC
  • AAMC & GQ reports
  • UMMS clinical skills report – reviewed by clerkship director annually
  • CCA2, FCS, CCA4 - reviewed by clerkship director annually
  • USMLE Step 2 & national Subject Exam averages

Contact Us

Karla Robinson

Surgery Education Facilitator, Undergraduate

Medical Student Program Coordinator