Prerequisites

1. Student in good standing at Mayo Clinic Alix School of Medicine or other accredited medical school.
2. Satisfactory completion of third-year surgery rotation.
3. Promotion to fourth-year status, and no failures in third-year core clerkship (visiting students).

Description

The subinternship is designed for the fourth-year medical student seriously interested in pursuing a career in surgical oncology. The subinternship should provide an experience comparable to a month of surgical internship, during which the student will function as a G-1 resident under the supervision of the senior resident or chief resident and Surgical Oncology Consultant.

The student will have the option to rotate on one of three services focusing on surgical oncology: colon & rectal; hepatobiliary; and breast/endocrine/melanoma/sarcoma. There will be intense and focused exposure to the surgical treatment of gastrointestinal, liver, pancreas, biliary, endocrine, and breast cancer. Much of the teaching will be one-on-one with the consultant. The student will be responsible for making arrangements for his/her subinternship with the consultant; this arrangement should be made several months ahead of time in order to facilitate minimal on-call scheduling.

Specific goals

1. To learn to participate as an integral part of the surgical team in the management of adult cancer patients.
2. To refine history and physical examination skills.
3. To learn to formulate a surgical problem list and prioritize management.
4. To learn the cost-effective selection of pre-operative imaging studies, and laboratory tests.
5. To learn when surgical intervention is indicated, and when patients are better treated by other multimodality means.
6. To learn post-operative management of complicated surgical patients.
7. To learn about adjuvant therapy for surgically resected cancers, and help plan ongoing care and surgical follow-up of dismissed patients.
8. To learn AJCC Cancer Staging for common sites and understand the differences in clinical and pathologic staging.

Relational goals

1. To demonstrate the close working relationship between surgery, medical oncology, radiation oncology, social service, nutrition, pharmacy, critical care, gastroenterology, and others in the comprehensive care of cancer patients.
2. To demonstrate how clinical research trials are integrated into clinical practice.
3. To understand the Mayo Comprehensive Cancer Center and the Cancer Program approved by the American College of Surgeons Commission on Cancer.
4. To learn to apply basic knowledge of common cancers, their mode of spread, and likely sites of metastases into the surgical resection of tumors.
5. To use this basic knowledge of common cancers to formulate treatment plans for complex tumors which cross into other surgical specialties.

Objectives

Pre-operative

• Perform history and physical examinations on surgical oncology patients seen in outpatient consultation at Mayo Clinic in Jacksonville, Florida.
• See surgical oncology consults in the hospital, perform history and physical examination, review imaging studies, and present the consult to the consultant on rounds.
• Discuss work-up with the attending, and review CT/MRI studies as necessary.
• Perform and write up an efficient history and physical on all patients admitted to the surgical oncology hospital service.
• Write all preoperative orders.
• Prepare for the next day's surgery by reading about anatomy, surgical pathology and techniques.
• Be familiar with current literature on the patient's specific cancer site.

Operative

• Acquire operative skills as an assistant on the surgical team.
• Be available to scrub on all operations performed by the surgical team.
• Review surgical pathology from frozen sections.
• Learn operations for hepatobiliary, pancreatic, and gastrointestinal neoplasms, and breast cancer.
• Learn techniques for sentinel lymph node biopsy.

Post-operative

• Follow post-op patients in the ICU and on the surgical floor.
• Manage postoperative patient problems appropriately.
• Learn postoperative care for all patients on service.
• Document patient progress with daily notes to be done before morning rounds.
• Discuss necessary treatment recommendations with senior or chief resident.
• Present patients to the staff on rounds.
• Round on the patients in the late afternoon or after surgery and follow-up on problems.
• Participate in planning for adjuvant therapy following discharge.
• Participate in post-operative outpatient visits.

Miscellaneous

• Attend and participate in all surgical conferences.
• Students will attend the weekly multidisciplinary Tumor Board conference, and present appropriate patients.
• Students will review and discuss incidence, diagnosis, treatment, and survival for the most common cancer sites.
• Basics of medical oncology and radiation oncology will be discussed.
• Present cases and papers to peers for educational purposes.
• Communicate with cross-coverage, appropriately "signing-out" patients.
• Maintain good communication with the Consultant senior or chief residents, patients, and family members to discuss progress and problems.
• The subintern will carry a service pager all days and nights on call.
• All hospital orders will need to be co-signed by a senior resident on the service or resident on-call.
• The subintern will take hospital emergency call with the surgical oncology surgical team (approximately once a week, and one weekend per month).
• At all times, maintain the highest standards of integrity, efficiency, and dependability as the acting surgical intern.
• Perform procedures when possible, i.e. ABGs, NG tubes, central lines, intubation.
• The subintern should wear a nametag at all times.
• Absences should not be scheduled during the subinternship.

Duration of rotation

One month

Dress

Appropriate Mayo Clinic dress for Outpatient Clinic. Hospital scrub suits for surgery.

Method of evaluation

Grading for the surgical subintern will be based on evaluations submitted by the consultant, chief resident, and senior residents. Grading is on the five-point system (Honors, High Pass, Pass, Marginal Pass, and Fail).

Per Mayo Clinic institutional policy, faculty and residents/fellows will not complete any outside evaluations. You will be provided with an electronic performance evaluation via Mayo Clinic’s MedHub portal. A final summative evaluation will be sent to you and your school official upon completion of your clerkship.