1. 2012 SURGERY Proposal for Changes Third Year Surgery Clerkship Third Year Surgery Clerkship

2. Surgery Clerkship 1987 Dr. Michael Zinner arrives as new Chairman of Surgery 1987 Dr. Michael Zinner arrives as new Chairman of Surgery 1992 Dr. Edward Livingston appointed Clerkship Director,Residency Director 1992 Dr. Edward Livingston appointed Clerkship Director,Residency Director 1993 Surgery Clerkship Partitioned: 1993 Surgery Clerkship Partitioned: Surgery I (6 weeks of 3rd Year Surgery) and Surgery I (6 weeks of 3rd Year Surgery) and Surgery II (6 weeks of 4 th Yr Surgery) Surgery II (6 weeks of 4 th Yr Surgery)

3. 1993 Partition 1993-4 New Surgery Clerkship implemented 1993-4 New Surgery Clerkship implemented Reaction from students and faculty was overwhelmingly negative Reaction from students and faculty was overwhelmingly negative Multiple Problems: Multiple Problems: with continuity of curriculum with continuity of curriculum students not completing required course in time for graduation students not completing required course in time for graduation students had difficulty with separation of content students had difficulty with separation of content

4. 1994 Surgery 1994 Dr. Carmak Holmes, new Chairman of Surgery, Dr. Ronald Tompkins, Vice-Chair for Education, Dr. Hugh Gelabert, Clerkship Director Dr. Carmak Holmes, new Chairman of Surgery, Dr. Ronald Tompkins, Vice-Chair for Education, Dr. Hugh Gelabert, Clerkship Director Tried to make the partitioned clerkship work – to no avail Tried to make the partitioned clerkship work – to no avail 1995 Petitioned MEC to allow Surgery Clerkship to revert to continuous 12 weeks 1995 Petitioned MEC to allow Surgery Clerkship to revert to continuous 12 weeks

5. 1994-1995 MEC MEC - period of curricular reform MEC - period of curricular reform Introduction of PBL Introduction of PBL Introduction of CPX Introduction of CPX Introduction of standardized patients Introduction of standardized patients Initiatives by California Legislature and National Political impetus to prioritize primary and ambulatory care Initiatives by California Legislature and National Political impetus to prioritize primary and ambulatory care

6. 1995 MEC Directives 1995 MEC Directive to strengthen physical diagnosis 1995 MEC Directive to strengthen physical diagnosis Early CPX data indicated UCLA students fared poorly in several areas Early CPX data indicated UCLA students fared poorly in several areas Surgery Department Tasked with teaching several areas of physical exam: abdomen, vascular, ENT, orthopedic, & GU exams Surgery Department Tasked with teaching several areas of physical exam: abdomen, vascular, ENT, orthopedic, & GU exams

7. 1995 Surgery Proposal 1995 Surgery Proposal: 1995 Surgery Proposal: Combined Ambulatory Surgery and In-Patient Surgery Clerkship: 6 weeks & 6 weeks to run consecutively as a 12 week block Combined Ambulatory Surgery and In-Patient Surgery Clerkship: 6 weeks & 6 weeks to run consecutively as a 12 week block Introduction to Surgery Week: multidisciplinary lectures and modules Introduction to Surgery Week: multidisciplinary lectures and modules Emphasis on tasked areas of physical diagnosis: Specific lectures, PE Modules Emphasis on tasked areas of physical diagnosis: Specific lectures, PE Modules

8. 1995 Surgery Proposal 1995 Surgery Proposal: 1995 Surgery Proposal: Revision of Surgery clerkship Curriculum to emphasize material common to all practitioners (with regard to primary care directives) Revision of Surgery clerkship Curriculum to emphasize material common to all practitioners (with regard to primary care directives) Integration of PBL into curriculum Integration of PBL into curriculum Integration of Doctoring into curriculum Integration of Doctoring into curriculum Integration of Radiology into curriculum Integration of Radiology into curriculum

9. 1995 Surgery Proposal 1995 Surgery Proposal 1995 Surgery Proposal Ambulatory Clerkship – 6 weeks duration Ambulatory Clerkship – 6 weeks duration Elements: ENT, Orthopedics, Urology (per MEC tasking), Anesthesia, Ophthalmology, Plastic Surgery or Neurosurgery included in 6 rotations, each 1-week long Elements: ENT, Orthopedics, Urology (per MEC tasking), Anesthesia, Ophthalmology, Plastic Surgery or Neurosurgery included in 6 rotations, each 1-week long

10. 1995 Surgery Proposal 1995 Surgery Proposal 1995 Surgery Proposal General Surgery Clerkship – 6 week duration General Surgery Clerkship – 6 week duration Elements: General Surgery rotation balancing County / VA experience with Tertiary Hospital experience Elements: General Surgery rotation balancing County / VA experience with Tertiary Hospital experience 2 rotations, each 3 weeks long. 2 rotations, each 3 weeks long.

11. 1995 Surgery Proposal 1995 Surgery Proposal: 1995 Surgery Proposal: Additional Departmental Initiatives Additional Departmental Initiatives Residents as Educators program Residents as Educators program Faculty Development Faculty Development Surgery Education Departmental Retreats Surgery Education Departmental Retreats Surgical Education Grand Rounds, Invited Lecturers Surgical Education Grand Rounds, Invited Lecturers

12. 1996 Surgery 1995-6 Surgery Clerkship reformed and implemented 1995-6 Surgery Clerkship reformed and implemented Overall reception very good Overall reception very good Recognition for innovation and successful implementation Recognition for innovation and successful implementation

13. 2004 Dr. Ronald Busuttil, ChairmanSurgery Department Dr. Ronald Busuttil, ChairmanSurgery Department Dr. Jonathan Hiatt, Vice Chair for Surgery Education Dr. Jonathan Hiatt, Vice Chair for Surgery Education Dr. Hugh Gelabert, Clerkship Director Dr. Hugh Gelabert, Clerkship Director Review of Clerkship and Curriculum Review of Clerkship and Curriculum Review of Surgery Residency Review of Surgery Residency

14. UCLA SOM 1996-2010 PDA initiative Development of Digital education Centralization of QI data: Student Surveys Angel Educational Competencies

15. UCLA SOM 2006-2009 2006-2009 Implemented new curriculum for 1 st and 2 nd years Implemented new curriculum for 1 st and 2 nd years Implemented Colleges in 4 th year Implemented Colleges in 4 th year Task force to review 3 rd year – Dr Hiatt Task force to review 3 rd year – Dr Hiatt

16. 2010-12 Surgery Issues Clerkship Problems Clerkship Problems Evaluation and feedback cycle too long Evaluation and feedback cycle too long One week rotations are too short One week rotations are too short Difficulty integrating to clinical teams Difficulty integrating to clinical teams Students seen as ‘tourists’ Students seen as ‘tourists’ Difficult to evaluate or provide constructive feedback Difficult to evaluate or provide constructive feedback Some rotations are removed from central objectives of teaching core Surgery Curriculum Some rotations are removed from central objectives of teaching core Surgery Curriculum

17. 2012 Surgery Proposal Surgery Clerkship Committee Surgery Clerkship Committee Dean’s Office: Deans Wilkerson, Parker, Hiatt, Carl Stevens, Sara Kim Dean’s Office: Deans Wilkerson, Parker, Hiatt, Carl Stevens, Sara Kim Anesthesia: Mitchell Lin Anesthesia: Mitchell Lin ENT: Vishad Nabili ENT: Vishad Nabili General Surgery: Hugh Gelabert, Chris DeVirgilio, David Chen, Bryne Lee, Jessica O’Connell, Mark Sawicki, Shirin Towfigh, Darin Saltzman, Nova Foster General Surgery: Hugh Gelabert, Chris DeVirgilio, David Chen, Bryne Lee, Jessica O’Connell, Mark Sawicki, Shirin Towfigh, Darin Saltzman, Nova Foster Neurosurgery: Isaac Yang Neurosurgery: Isaac Yang Ophthalmology: Gary Holland, JoAnn Giaconi Ophthalmology: Gary Holland, JoAnn Giaconi Orthopedics: Jeff Eckardt, Sharon Hame Orthopedics: Jeff Eckardt, Sharon Hame Plastic Surgery: Charles Tseng Plastic Surgery: Charles Tseng Transplantation: Fady Kaldas Transplantation: Fady Kaldas Urology: Larissa Rodriguez Urology: Larissa Rodriguez Vascular: Steven Farley Vascular: Steven Farley

18. 2012 Surgery Proposal Reform of Surgery Clerkship Reform of Surgery Clerkship Consolidate Subspecialties to allow more time with each rotation Consolidate Subspecialties to allow more time with each rotation Minimum duration 2 weeks, oriented towards integrated participation in services Minimum duration 2 weeks, oriented towards integrated participation in services Require participation in 2 of: Ortho, GU, ENT Require participation in 2 of: Ortho, GU, ENT Allow choice of 1 of Ophthalmology, Neurosurgery, Transplant, Cardiac, Thoracic, Plastic, Anesthesia, Ortho, GU, ENT Allow choice of 1 of Ophthalmology, Neurosurgery, Transplant, Cardiac, Thoracic, Plastic, Anesthesia, Ortho, GU, ENT

19. 2012 Surgery Proposal Revise Curriculum Revise Curriculum Emphasis on competencies in education Emphasis on competencies in education Competency based reviews and exercises (Case Log, Mini-CEX, Practical Exam) Competency based reviews and exercises (Case Log, Mini-CEX, Practical Exam) Quality Initiatives: student oriented analysis of cases and outcomes Quality Initiatives: student oriented analysis of cases and outcomes

20. 2012 Surgery Proposal Revise Evaluation and Feedback Revise Evaluation and Feedback Continue mid-clerkship evaluation and feedback to be given in person to students Continue mid-clerkship evaluation and feedback to be given in person to students Require ESS evaluations from specialty rotations Require ESS evaluations from specialty rotations Continue the “Three Line” evaluation Continue the “Three Line” evaluation Overall assessment Overall assessment Constructive criticism Constructive criticism Confidential comments Confidential comments

21. 2012 Surgery Proposal Current Current 6 week Gen Surg 6 week Gen Surg 6 week Ambulatory 6 week Ambulatory Amb: 1 week long rotations Amb: 1 week long rotations 5 Required Subspecialties 5 Required Subspecialties Random Assignment Random Assignment Proposed Proposed 6 week Gen Surg 6 week Ambulatory Amb: 2 week long rotations 2 Required subspecialties, 1 choice Student selection of assignments from 9 choices Incorporation into teams (inpatient and ambulatory)

22. 2012 Surgery Proposal Current Current ESS Evaluation at end of clerkship ESS Evaluation at end of clerkship Separated constructive, supportive, and confidential feedback Separated constructive, supportive, and confidential feedback Traditional curriculum Traditional curriculum Departmental M&M sessions Departmental M&M sessions Proposed Proposed Mid-clerkship feedback, ESS Evaluation Separated constructive, supportive, and confidential feedback Competency based curriculum (Case Log, CEX) Content: Departmental M&M sessions, Didactics, and Online Resources

23. 2012 Surgery Proposal Anticipated Benefits Anticipated Benefits Improved student integration to services Improved student integration to services Improved student participation Improved student participation Improved student evaluation Improved student evaluation Improved curriculum (competencies, QI) Improved curriculum (competencies, QI) Overall: Improved Educational Experience Overall: Improved Educational Experience