MS4 Catalog

Colorectal Surgery

LOCATION: Ruby Memorial/Physician Office Center, Morgantown, WV
PRECEPTOR: Douglas Murken, MD
ADJUNCT PRECEPTORS: Dr. Emily Groves, Dr. Kevin Train, Dr. Riaz Cassim and Dr. Keri Mayers
DURATION: 2 or 4 weeks (4 weeks encouraged)
OFFERED: Continuously
MAXIMUM ENROLLMENT: 2
STATUS: Elective

OBJECTIVES:

The purpose of this elective is to provide an in-depth experience in Colorectal Surgery for students interested in general surgery or internal medicine/gastroenterology.  Students will participate in patient care in both inpatient and outpatient settings and will be exposed to a variety of procedures including colonoscopy, minimally invasive/robotic and open major abdominal surgery, and outpatient anorectal surgery.  The rotation will provide exposure to a variety of malignant and benign colorectal diseases including but not limited to colorectal cancer, anal cancer, inflammatory bowel disease, diverticulitis, pelvic floor and benign anorectal disorders.   Students will engage with all 5 faculty members during the time on service. 

Objectives for the rotation include, but are not limited to, gaining an understanding of:
(1) Pre-operative patient management and selection for surgery with an emphasis on imaging, colonoscopy, and pathology review.
(2) Common colorectal operations including colonoscopy, colon resections, ileostomy/colostomy creation, and anorectal examinations under anesthesia.
(3) Post-operative care with an emphasis on fluid and electrolyte management, ERAS protocol, wound/ostomy/drain care.
(4) The role of the colorectal surgeon in the multidisciplinary approach to colorectal cancer patients (collaboration with Radiology, Med Onc, Rad Onc) and in the interdisciplinary care of patients with inflammatory bowel disease (IBD) (collaboration with Gastroenterology).

Students will be responsible for delivery of patient care in the in-patient setting by serving as a Sub-intern of the Colorectal Surgery Service. 

Responsibilities will include:

  • Following patients on whom they have operated, participating in their post-operative care, presenting the patient on daily rounds, and communicating relevant clinical updates with the responsible faculty.
  • Sharing day-today “floor” responsibilities with the resident staff and APPs under faculty supervision.
  • Seeing patients in the outpatient setting by attending clinic 1-2 days per week.
  • Attendance at Departmental M&M/Grand Rounds as well as Multidisciplinary Tumor Board and IBD Conferences.
  • Participating in elective and emergent colorectal operations and colonoscopies.
  • Inpatient- students will participate on daily morning inpatient rounds with the resident/APP team and will be encouraged with round with a faculty member each day as well. Floor work can be done throughout the day as time allows but after the completion of rounds students will be directed to either the operating room or clinic for the majority of the day.  There will be opportunity to see and participate in the care of new inpatient consults.
  • Outpatient – students will attend outpatient clinic 1-2 days per week. The experience can be tailored per the students preference.
  • Operative – students will participate in a variety of endoscopic or operative procedures usually as second assist.

Patient Care:

  • Gather and interpret a complete and appropriately organized medical history, which incorporates cultural features for comprehensive patient care.
  • Select and interpret appropriate physical examination findings, diagnostic tests, laboratory tests, ultra-sonographic imaging and standard imaging studies to formulate a complete and accurate differential diagnosis.
  • Participate in basic medical procedures (i.e., endoscopic or operative procedures) appropriately and professionally.
  • Collaborate with an interprofessional team to provide preventive, acute, chronic, rehabilitative, and end-of-life care that is patient-focused and cost-effective.

Medical Knowledge:

  • Identify the staging and management algorithms for colon, rectal, and anal cancer (with an emphasis on NCCN guidelines).
  • Identify the role of elective or emergency surgery in the management of patients with Ulcerative Colitis or Crohn’s Disease (with an emphasis on Clinical Practice Guidelines (CPG) from the American Society of Colon and Rectal Surgeons (ASCRS)).
  • Distinguish principles of surgical management of common benign anorectal conditions including hemorrhoids, perirectal abscess, fistula in ano, and condyloma/AIN.
  • Identify the different types of intestinal stomas including indications for and construct of.
  • Recognize the importance of pre-operative colonoscopy and how findings translate to operative planning.
  • Distinguish colorectal disease including diverticulitis, rectal prolapse, pelvic floor dysfunction.

Practice-Based Learning:

  • Utilize evidence-based care in selecting patients for surgery and deciding what operation is indicated.
    • Use the NCCN Guidelines and CPGs from ASCRS in patient care.
  • Contribute Interdisciplinary IBD Conference and Multidisciplinary Tumor Board in order to understand how practice guidelines are created and implemented.

Communication Skills:

  • Exhibit the ability to respectfully and effectively develop a collaborative relationship with fellow students, APPs, residents, and staff both in terms of patient care and education.
  • Utilize the feedback provided by preceptors and surgical team members both in the operating room and in the inpatient/outpatient care settings.
  • Introduce self and identify role to all members of the operating room team.
  • Delivers effective patient presentation during morning rounds and in clinic.

Professionalism:

  • Arrives on time for morning rounds, clinic, and operations (be in the room when the patient gets into the room).
  • Treats students, faculty, staff, and other personnel with respect.
  • Accepts responsibility and is accountable.

Systems-Based Practice: 

  • Identify barriers to care that many of our patients with colorectal cancer or complex IBD experience and how we can work to consolidate care.
  • Explain the role that academic Colorectal Surgeons and Gastroenterologists at WVU Ruby Memorial Hospital (tertiary care referral center) plays in the state of WV in terms of caring for patients with Rectal Cancer and complex IBD and how we must collaborate/interface with community providers to assure continuity of care.
  • Identify the importance of interdisciplinary care in the management of our patients:
    • Collaborating with Gastroenterology in IBD care
    • Collaborating with Med Onc and Rad Onc in cancer care
    • Collaborating with Urology, Gynecologic Oncology, and Plastic Surgery in surgical management

METHODS TO ACHIEVE OBJECTIVES:

Students will work closely with the 5 colorectal surgery faculty members.  The preceptor (Dr. Murken) will be charged with ensuring adherence to the above learning objectives.  In addition, each faculty member will provide constructive feedback throughout the rotation regarding each student’s performance with inpatient care, in clinic, and in the operating room. 

Students will also have a plethora of other resources, including but not limited to:

EXAMINATION PROCEDURES AND EVALUATION CRITERIA:

Formative Assessment:

Students will prepare a 15-minute presentation to the faculty on a current controversy in colorectal surgery by focusing on a current journal article in that month’s edition of DCR (Diseases of the Colon and Rectum).

Summative Assessment: 

Students will receive direct feedback from the Faculty Preceptor and Adjunct Preceptors regarding their performance.

PRIOR TO THE FIRST DAY OF THE ROTATION:

Please contact Rochelle Thomas, rochelle.thomas@hsc.wvu.edu two weeks prior to rotation start date.