Rotation Director Bruce Schirmer, M.D. 

Attendings:   Peter Hallowell, M.D. 

Fellow:  M. Logan Rawlins, M.D.

Course Curriculum

The Orange Surgery Service focus emphasizes gastrointestinal diseases and procedures of the upper gastrointestinal system as well as the treatment of hernias. Resident staff for the service includes for this year a PGY-5, a PGY-3 or PGY-2, and one or two PGY-1 residents.  Support staff for the Orange Surgical Service include Anna Dietrich-Covington, R.N., and Libby Rexrode, R.N. who cover all inpatient and outpatient care for the Orange Surgery Service.  Ms. Rexrode primarily works with Dr. Hallowell’s patients while Ms. Covington primarily works with Dr. Schirmer and Rawlins’ patients.  Dietitians Rebecca Puffer and Kelli Hughes are also involved in assisting the nutritional needs and education of patients on the Orange Service.  Michael Miller is in charge of data management and insurance approvals for bariatric patients.  

Learning Objectives:

Upon completion of the Orange surgery rotation students should be able to:

1.    Discuss the pathophysiology and associated medical problems of severe obesity

2.    Discuss the variations in physiologic responses in the severely obese, and their relevance to operative and postoperative care and as signs of complications.

3.    Discuss the indications and contraindications for a laparoscopic approach to surgery of the upper gastrointestinal tract.

4.    Discuss the pathophysiologic changes that occur during laparoscopic surgery, and the appropriate measures to ensure safe conduct of a laparoscopic operation.

5.    Discuss the evaluation and treatment of gastroesophageal reflux disease.

6.    Discuss the indications and appropriate approaches for repair of hernias of the abdominal wall and inguinal region.

7.    Discuss the indications and surgical approach for treating patients with calculous and calculus biliary tract disease, including methods of intraoperative imaging of the biliary tree.

8.    Discuss the treatment of common complications of postoperative patients undergoing gastrointestinal tract surgery.

9.    Understand how to develop a plan of care for all in-house surgical patients with whom they come in contact including patients with morbid obesity. This includes data collection, ordering and interpreting appropriate diagnostic tests, and working to provide a patient-centered plan in coordination with the residents.

10. Recognize significant changes in patient status.

Responsibilities

Medical Students should accompany the residents and participate in all aspects of patient care. The Orange Surgery team will be expected to perform the following:

1.    Provide all appropriate inpatient care for patients admitted to the Orange service.

2.    Provide all appropriate outpatient care for the above patients, as well as those outpatients seen in the clinics and in consultation with attendings from the Orange surgery service.

3.    Participate routinely in the operative treatment of those patients who have been seen by the team, and especially if possible by individual resident members of the team, during the preoperative period.

4.    Learn the appropriate postoperative care, both inpatient and outpatient, for patients with the problems outlined above.

5.  Participate in minimally invasive surgery for treatment of problems of the   upper gastrointestinal system.

6.  Participate in open surgery for similar problems of the gastrointestinal system, particularly in situations where a laparoscopic approach is not indicated or possible.

7.  Review appropriate laboratory and study data results, reporting the status of each patient and their studies on rounds, and participating in the daily patient documentation in the chart as feasible by current electronic medical standards..

8.   Assist the resident on the service in performing a full written history and physical examination on the day of admission for all patients.  Understand the measures necessary to arrange the post-discharge care and orders and medications and follow-up, in coordination with the appropriate care coordinator for that patient.

9.  Participate in Conference immediate following clinic on Tuesdays (DHC) and Thursdays (Surgery Clinic).

Weekly walk rounds and clinics will be used to assess student progress in mastering the fundamentals of patient care and management for pathophysiology seen on the service. Communication skills will be emphasized in the outpatient clinic, when obtaining information from patients, summarizing it in an appropriate presentation, and then assisting in patient documentation as appropriate and permissible by current electronic medical record methods. Many such documentations will be in the form of assisting a resident with the pertinent information.  Similar communication skills will be employed in the care and communication and documentation of inpatients.