Introduction: Operative and technical skills focusing specifically on the basic procedures expected of surgical interns are important topics that are not uniformly covered in medical schools. We developed a course for incoming surgical interns incorporating didactics, simulation, and supervised skill practice, aimed to improve surgical intern readiness for expected procedures encountered in surgical care. Methods: This resource includes comprehensive materials intended to provide senior medical students with the basic operative and technical skills to care for surgical inpatients. The materials provided were designed for use as part of a preparatory course for fourth-year medical students entering surgical specialties, and include instructor's blueprints, PowerPoint slides, and handouts for five separate sessions. A multiple-choice knowledge test is also included as one of these sessions. This resource may be used by course directors for surgery PGY-1 preparatory classes/bootcamps, for independent study by individuals planning to matriculate into surgical residencies, or as a review source for those already in surgical training. Results: Learners demonstrated objective improvement in testing of cognitive skills and performance in simulated scenarios and procedures. Upon course completion, participants reported high confidence in executing skills, suggesting improved readiness for operative and technical skills necessary to care for the surgical inpatient. Discussion: We feel that by significantly augmenting intern readiness, we heightened the safety and effectiveness of the medical care provided to our patients. While these materials were designed to meet the needs of new surgical house staff, the contents are easily generalizable to other medical specialties, and would prove useful for any trainee managing hospital inpatients.
- Identify monofilament and braided, absorbable and non-absorbable suture.
- Identify taper and cutting needles and their uses.
- Identify suture sizes.
- Differentiate among simple, horizontal mattress, vertical mattress, and subcuticular suture patterns.
- Describe situations when each of the above suture patterns is used.
- Differentiate between a Granny (slip knot), Square, and Surgeon’s knot.
- Describe hand positions and list steps in executing one- and two-handed knots (Granny, Square, and Surgeon’s).
- Describe hand positions and list steps in executing instrument-tied knots (Granny, Square, and Surgeon’s).
- Explain the rationale and indications for using each kind of knot and each technique.
- Based on the application and qualities of local anesthetics, choose the correct one and determine its toxic dose.
- Describe the three phases of patient skin preparation.
- Discuss recommendations for pre-operative hair removal.
- Based on the various properties of prep solutions, choose the best agent for prepping a designated site.
- Describe hazards for the patient related to various prep agents.
- Describe a prep that includes a “dirty” site.
- Describe the correct prep of the abdomen and perineal area for one procedure.
- Categorize surgical procedures using the wound classification system.
- Categorize surgical wound infections using the Classifications of Surgical Site Infection designations.
- Identify major sources of contamination of surgical wounds.
- Discuss principles of aseptic technique.
- Discuss considerations in choosing gloves.
- Discuss factors to consider when determining the need to double glove.
- List equipment needed for central venous line placement (subclavian and internal jugular).
- Describe how to obtain patient consent.
- Describe every step of the line-placement procedures.
- Describe anatomy of all areas involved with line-placement procedures.
- Define all indications, contraindications, potential complications, and the management of line-placement procedures.
- Describe the basic anatomy of the chest wall and ideal site for a chest tube.
- List indications, contraindications for using a chest tube.
- Describe which size chest tube are appropriate for a given situation.
- Describe the operative steps of chest tube placement.
- Describe proper pain management for a chest tube.
- Draw and explain a three-bottle chest tube system.
- Close wounds (epidermal approximation) using each suture pattern (simple, horizontal mattress, vertical mattress, and subcuticular).
- Demonstrate efficient instrument and tissue handling.
- Execute Granny, Square, and Surgeon’s knots in a series, using the two-handed technique.
- Execute the same series as above using one-handed ties with the dominant hand.
- Execute the same series as above using one-handed ties with the non-dominant hand.
- Execute the same series as above using instrument ties.
- Display correct “squaring” of the throws.
- Avoid “air knots.”
- Demonstrate the correct technique for drawing up, measuring, and administering local anesthetics.
- Perform a scrub/paint prep of an abdomen.
- Perform a scrub/paint prep of an extremity using Duraprep.
- Prep an abdomen using Chloraprep.
- Demonstrate surgical hand scrub procedure.
- Demonstrate correct application of Avagard.
- Aseptically gown self.
- Aseptically glove self.
- Properly place a central line in subclavian vein in a synthetic model.
- Properly place a central line in an internal jugular vein in a synthetic model.
- Properly place an arterial line in the radial artery.
- Effectively conduct a Doppler examination in a peer.
- Feel the surface landmarks of the chest wall.
- Demonstrate ideal body position for chest tube placement.
- Prepare a chest tube kit and necessary equipment.
- Successfully place a chest tube.
- Review indications for intubation.
- Describe respiratory compromise.
- Discuss the indications and uses of supplemental oxygen, mask ventilation, and endotracheal intubation.
- Review airway anatomy.
- Discuss supplies for intubation.
- Discuss technique for intubation in a large group setting prior to practicing on simulators in breakout rooms.
- Provide opportunity for supervised practice and feedback in several previously instructed areas: prepping, gowning, and gloving; local anesthetic injection; suturing and knot tying; and placement of chest tubes, central lines, and arterial lines.
- Encourage practice with the endoscopy simulators (pending availability).
- Provide exposuare to robotics simulators.
None to report.
None to report.
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Antonoff MB, D’Cunha J. Improving the transition to surgical internship: increased confidence and anxiety reduction through formal preparatory instruction. Presented at: Minnesota Surgical Society, Fall Conference; October 24, 2009; Rochester, MN.
Antonoff MB, Maddaus MA, D’Cunha J. Improving the transition to surgical internship: increased confidence and anxiety reduction through formal preparatory instruction. Presented at: 5th Annual Academic Surgical Congress; February 3, 2010; San Antonio, TX.
Antonoff MB, Swanson JA, Acton RD, Chipman JG, Maddaus MA, Schmitz CC, D’Cunha J. Improving surgical intern confidence through the implementation of expanded orientation sessions. Presented at: 5th Annual Academic Surgical Congress; February 3, 2010; San Antonio, TX.
Antonoff MB, D’Cunha J. The benefit of a targeted intervention to improve the transition to surgical residency. Presented at: Association for Surgical Education, Surgical Education Week; April 24, 2010; San Antonio, TX.
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Antonoff MB, Green CA, Reihsen TE, Sweet R, Maddaus MA, D’Cunha J. A simulation-based critical skills course for surgical interns: mid-term analysis. Presented at: Association of American Medical Colleges Annual Meeting, Modernizing Medicine MedEdPORTAL Poster Session; November 6, 2010; Washington, DC.
Antonoff MB, Maddaus MA, D’Cunha J. Beyond the surgical bootcamp: evaluation of a competency-based curriculum for senior medical students entering surgical internship. Presented at: 6th Annual Academic Surgical Congress; February 3, 2011; Huntington Beach, CA.
Antonoff MB, Maddaus MA, D'Cunha J. PGY-1 preparatory curriculum design: tailoring content to the modern trainee. Presented at: Association for Surgical Education Annual Meeting; March 22, 2011; Boston, MA.
Antonoff MB, D'Cunha J. Competency-based preparation of senior medical students for surgical internship: impact upon task-specific confidence and competence. Presented at: Surgical Education Research Fellowship Forum, Association for Surgical Education Annual Meeting; March 23, 2011; Boston, MA.
Antonoff MB, D'Cunha J. Development of PGY-1 surgery preparatory course curricula: identification of key curricular components. Presented at: Association of Program Directors in Surgery Annual Meeting; March 25, 2011; Boston, MA.
Antonoff MB, Whitson BA, Green CA, Maddaus MA, D’Cunha J. Preparation of the senior medical student for integrated surgery training: significant impact of a competency-based course. Presented at: American College of Surgeons 97th Annual Clinical Congress; October 25, 2011; San Francisco, CA.
Antonoff MB, Green CA, Swanson JA, Maddaus MA, D’Cunha J. Prospective Analysis Of The 2-Year Outcomes From A Competency-Based Preparatory Course For The PGY-1 Resident: Modeling Standards For The Future. Presented at: 7th Annual Academic Surgical Congress; February 14-16, 2012; Las Vegas, NV.
Green CA, Antonoff MB, Swanson JA, D'Cunha J. Preparing Medical Students for Residency Training: 2-year Cumulative Analysis of a Model Preparatory Course. Presented at: Minnesota Surgical Society, Spring 2012 Meeting; May 4, 2012; St. Paul, MN.
Green CA, Antonoff MB, Swanson JA, D’Cunha J. Competency-based Preparation of Senior Medical Students for Residency Training: 2-year Cumulative Analysis of a Model Preparatory Course. Presented at: Association of Women Surgeons Starr Poster Session, AWS Fall Conference; September 30, 2012; Chicago, IL.
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