Surgery: An integral part of core curriculum

Abstract

The surgical clerkship is under attack from several quarters and has been reduced or eliminated in many schools. Exposure to the diagnosis and management of routine surgical disease is thus impaired, and training in the care of acutely ill or traumatized patients is virtually eliminated. A well-balanced “core” curriculum demands such exposure, and these objectives are being fulfilled by a structured 11-week surgical rotation at Wayne State University. Instruction in elective surgery assumes three forms: (1) morning tutorials, where each of five groups of seven junior clerks meets daily with a staff member for a 1-hour, predefined, case-oriented tutorial; (2) ward rounds, where each division meets with its staff member two times weekly for a student-oriented round based on student presentation of an interesting case; and (3) specialty sessions, where all students meet weekly with the surgical specialties for an introduction to basic concepts and clinical management. Instruction in care of the acutely ill is provided in a 3 1 2 -week rotation on the Emergency Service at Detroit General Hospital. The students participate in (a) patient management problems twice weekly, directed toward emergency situations; (b) night duty every third night, on a 1:1 basis with a surgical resident, resuscitating injured patients; (c) daily tutorials designed to cover various specialty-oriented emergencies; and (d) instruction in orthopedic and neurosurgical emergencies. Student critiques provide guidance on deficiences in logistic support. Cognitive behavioral objectives are evaluated by multiple-choice, multidiscipline midterm and final examinations; behavioral objectives in the affective domain are evaluated by detailed rating scales of eight traits considered important in a physician. Ceaseless curriculum revision is invaluable in establishing an organized surgical course which provides a broad exposure to all areas of surgical management. Our aim is to produce a curriculum under constant revision of objectives and methods based upon evaluation of student performance. Such a dynamic curriculum is requisite to medical school education and must not be allowed to vanish from the scene.