Surgery (Clinical practice)
Code
11142
Academic unit
Nova Medical School | Faculdade de Ciências Médicas
Department
TRA - Surgery and Human Morphology
Credits
8
Teacher in charge
Prof. Doutor Rui Maio
Teaching language
Portuguese
Objectives
Clinical Skills:
- To know and correctly apply surgical language;
- To know main surgical syndromes understanding, its etiopathogenesis and semiology, as well as the fundamentals of its diagnosis and treatment;
- To be able to distinguish clinical situations with elective and urgent surgical indication;
- To know how to plan and perform a methodical and complete clinical examination;
- To know how to select and request the complementary diagnostic tests needed to clarify e ach
clinical case;
- To know how to evaluate the nutritional status and surgical risk of a patient;
- To know how to hierarchize data from a clinical history and formulate the diagnostic hypotheses;
- To know how to perform the most common small surgery techniques and know the techniques of anesthesia and asepsis necessary for this purpose.
Social training skills - behaviors and attitudes:
- To know how to respect patients and their families and know their rights and obligations;
- To know the ethical principles inherent in confidentiality and the adequate transmission of information necessary for the informed consent of surgical procedures;
- Know how to communicate properly and work as a team with colleagues, other health professionals and their superiors;
- Adopt a proactive attitude towards the development of the personal competencies inherent to the medical profession, especially as regards integrity, responsibility and interest in personal valuation;
- Recognizing the importance of lifelong medical training.
Prerequisites
Subject matter
Theoretical sessions:
o Leadership and teamwork - Eng. Isabel Vaz
o Principles of management in health care - Dr. Artur Vaz
o Role of simulation in pre-graduate teaching - Dr. Francisca Leite
o Clinical risk and performance in surgery Prof. Dr. Rui Maio
o Communication techniques - Dr. Graça Rosendo
o Managing stress and prevention of burnout - Dr. Pedro Rocha
o Nutrition and surgery - Prof. Dr. Marília Cravo
o Value-based medicine Prof. Dr. Rui Maio
o Trauma Evaluation And Management Dr. José Luís Ferreira
Theoretical-practical sessions:
o Behaviors and Attitudes in a Surgery Ward - Nurses Teresa Simões and Teresa Afonso.
o Training, supervision and acquisition of necessary skills for those who practice invasive techniques; Ethical considerations and informed consent - Dr. António Martins Batista.
o Basic principles of infection control; Technique for carrying out sterile procedures - Dr. Carlos Palos and collaborators.
o Placement of peripheral venous access / venipuncture; Handling of infusion systems and syringes; Intra-dermal injection, intramuscular injection, intravenous injection, subcutaneous injection; Blood culture harvest; Harvest of arterial blood; Peripheral arterial line placement; Placement of central venous catheter (jugular, subclavian, femoral) - Dr. António Messias and collaborators.
o Local anesthesia; Suture techniques; Abscess drainage; Approach of the patient with ingrown toenail; Approach to subungual hematoma Prof. Dr. Rui Maio and collaborators.
o To algaliarize; Suprapubic puncture - Dr. Rui Sousa and collaborators.
o Nasogastric tube insertion; Paracentesis; Rectal touch; Anuscopy Prof. Dr. Marília Cravo and collaborators.
o Immobilization of the shoulder; Immobilization of the elbow; Immobilization of the wrist and fingers; Dr. Paulo Rego and collaborators.
o Immobilization of the ankle; Plastered and elastic knee brace; Reduction of painful pronation in the child; Reduction of anterior shoulder dislocation - Dr. Paulo Rego and collaborators.
o Tracheal intubation (naso / oro); Difficult airway management; Emergency cricotiroidotomy - Dr. Miguel Ghira and collaborators.
o Thoracic drainage insertion; Thoracocentesis; Pleural biopsy - Dr. Sofia Furtado and collaborators.
o Principle of approach to severe polytrauma - Dr. Pedro Amado
o Primary approach of the polytraumatized Dr. Pedro Amado
Practical Teaching:
o Consultation: Follow-up of the tutor in the external consultation; Accomplishment of clinical history and objective examination; Discussion of diagnostic hypotheses and therapeutic proposals with the tutor; Realization of dressings.
o Admission: Daily observation of patients; Accomplishment of clinical history and clinical journals; Objective examination; Discussion of the diagnosis and therapeutic proposal of each case with the tutor; Realization of dressings.
o Operating room: Individual preparation for participation in surgical procedures; Participation in the surgical acts as 2nd assistant.
o Emergency: Tutoring during a period of 12 hours per week; Accomplishment of clinical history; Objective examination; Discussion of diagnostic and therapeutic proposals with the tutor; Accomplishment of acts in the small surgery; Disinfection and suturing of wounds; Drainage of abscesses.
o Service meetings and clinical sessions of the hospital: Participation in the clinical meetings of the General Surgery and Gastroenterology services and in the weekly clinical sessions of the Hospital.
Scientific curiosity and the capacity for self-learning will be stimulated through the performance of a presentation paper at a seminar held at the end of the internship period. These studies should cover a clinical case accompanied during the internship and include a literature review on the presented pathology.
The TEAM course is organized by ATLS Portugal and the Portuguese Society of Surgery, according to the educational format proposed by the American College of Surgeons for medical students. Its objectives are:
- Describe the fundamental principles of the Initial Approach;
- Identify the correct sequence of priorities for approach;
- Review adequate resuscitation techniques;
- To value the (known) history of the patient;
- Understand the mechanisms of each injury;
- Identify concepts of "teamwork" in the treatment of severe trauma.
The TEAM course integrates a theoretical component and a practical component with four practical stalls: Airway, Shock, Vertebro-medullary Trauma and RX in Trauma. It is held at the beginning of each rotation, and attendance at both the lectures and the practice stands in full is mandatory for the award of the Diploma of the Course. The basic support materials will be made available in Moodle.
Schedule:
|
|
Classes |
Theoretical component (8h30 10h00) |
Practical component (08h15-13h00 or 13h45-18h00) |
|
Courses 1 and 2 |
3 and 4 |
14-09-2017 |
15-09-2017 |
|
Courses 3 and 4 |
1 and 2 |
09-11-2017 |
10-11-2017 |
|
Courses 5 and 6 |
7 and 8 |
25-01-2017 |
26-01-2018 |
|
Courses 7 and 8 |
5 and 6 |
22-03-2017 |
23-03-2018 |
Bibliography
Basic bibliography, reference books, available software, most important sites, videos
- Current Surgical Diagnosis and Treatment G. M Doherty;
- Surgery Scientific Principles & Practice Greenfield´s;
- Cirurgia, Patologia e Clínica Alves Pereira;
- Textbook of Surgery Schwartz;
- Licenciado Médico em Portugal;
- The Tuning Project;
- Tomorrow´s Doctors;
- Relatório do Projeto Nacional de Avaliação das capacidades dos alunos que concluem os Cursos de Licenciatura em Medicina
- Current Surgical Diagnosis and Treatment G.M.Doherty, 12th edition, Lange Medical Books
- Cirurgia, Patologia e Clínica, Alves Pereira 2ª edição McGraw Hill
- Textbook of Surgery Schwartz
Teaching method
theoretical classes (lectures of an expositive nature, directed at large groups, lasting no more than 50m)
theoretical-practical classes (they integrate an expository component and an interactive component, directed to small groups)
Practical classes: clinics (supervised occupational situations and integrated into care work) and non-clinical (aiming at the execution of exercises and procedures in small groups under the supervision of a teacher)
At the end of the surgery internship students should have consolidated previous knowledge and obtained clinical and social skills considered essential for future professional practice.
With regard to clinical competences, students must demonstrate knowledge and know how to correctly evaluate the most common cynical situations, determine the priorities of action and establish the essential measures and procedures for their adequate resolution. They must also have performed or observed a number of pre-established procedures that will be registered in a performance book (log-book).
Regarding social skills, it is essential that students demonstrate that they can communicate correctly with patients and their families, valuing their perspectives, concerns and expectations. It is also essential to demonstrate their ability to communicate and integrate in team with their peers, other health professionals and their superiors, as well as their attitude expressed in the interest and motivation to acquire new knowledge and skills.
Evaluation method
o Theoretical, theoretical-practical and practical teaching
o In the evaluation process, three mandatory meetings are held during the internship between the tutor and the student scheduled according to the availability of both. These meetings should result in a registration in the individual process and validated by the tutor and the student.
o The work presented at the seminar will be subject to an isolated classification that will represent 10% of the final classification of the internship.
o Student attendance is checked through attendance sheets in each of the classes and there is no supplementary regime for students without attendance minimums.
o The evaluation of this UC translates into the final classification of the stage is given on a scale of 0 to 20 values. For this classification the following aspects contribute in a weighted way:
Level of knowledge demonstrated during the internship (NC) (20%);
Ability to integrate knowledge acquired in clinical practice (HF) (20%);
Quantity and quality of procedures performed (P) (15%);
Behaviors and attitudes in clinical practice (CA) (15%);
Assiduity (A) (10%);
Activity Report (AR) (10%);
Work presented at the seminar (TS) (10%).
Thus, the final classification (CF) is calculated using the following formula and presented on a scale of 0 to 20:
CF= (20 NC+20 IC+15 P+15 CA+10 A+10 RA+10 TS)/100