Guide Book April 2014

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Guidebook

Medical StudentClerkship Program SURGERY(C12A 001)

DEPARTMENT OF SURGERYFACULTY OF MEDICINE - UNIVERSITAS PADJADJARAN

Dr. Hasan Sadikin Hospital - Bandung

2014

Guidebook – Medical Student Clerkship Program in Surgery, April 2014

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INTRODUCTIONMedical clerkship or clinical rotation is a university based professional education after completion of bachelor degree in medicine. The purpose of medical clerkship is to train medical student for medical andclinical skills, to produce skilled and competent medical doctor.

Profession define as a paid occupation that involves prolongedtraining and formal qualification, which include development in ethical reasoning and building a positive attitude.

The goals of medical clerkship professional education is to create professional medical doctor, with capabilities for self improvement and enhancement, highly-skilled, ethical and full of compassion to patient, full responsibility, as well as always up to date in technology. After the completion of all training, it is expected that the end-product would be a highly competitive and internationally recognized medical doctor.

During hospital clerkship, it is expected that the student practicing the Indonesian code of medical ethics, as well as practicing good medical practice, good surgical practice, and the international code of medical ethics.

Surgery is a medical knowledge which study not only surgical skills, but include learning ethics, etiology, epidemiology, pathology, pathophysiology, treatment and management of disease or anomalies, holistically, which include medicine or non-surgical management as well.

The scope of surgery is divided into nine division:Digestive surgery, Oncologic surgery, Vascular Surgery, Pediatric surgery, Plastic surgery, Cardiothoracic surgery, Neurosurgery, Urology, and Orthopaedic.

TMD


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CONTENTSIntroduction 1Chapter I – Preface 4

Program description …………………………………………………Vision and Mission ………………………………….……………….General objectives …………………………………...………………Specific objectives …………………………………..……………….Clerkship duration …………………………………...………………Clerkship location …………………………………...……………….General rules ………………………………………...……………….Night shift rules ……………………………………...……………….Sanction ……………………………………………...……………….Exchange / Visiting Medical Student ………………………………Precautions …………………………………………………………...

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Chapter II – Department Faculties 10Teaching staff ………………………………………..……………….Medical Student Affairs ……..……………………….………………Facilities ……………………………………………….……………...

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Chapter III – Materials and Subjects 13Basic competencies in general surgical knowledge ……………..Psychomotor competencies ………………………….…………….List of competencies based on surgical division …………………List of competencies based on clinical skills ……………………..List of clinical skills given in undergraduate program ……………

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Chapter IV – Routine Activities 25Rotation duration …………………………………….………………Teaching and Learning method ……………………......................Weekly activities ……………………………………………………..Activity location ……………………………………..………………..Weekly Schedule for each Division ….…………...……………….

Digestive surgery …………………………………………..

Oncologic surgery …………………………...……………..

Pediatric surgery …………………………….……………..

Plastic surgery ……………………………….…………….

Urology ……………………………………...………………

Vascular surgery …………………………….…………….

Orthopaedic ………………………………….…………….

Neurosurgery ………………………………...…………….

Cardiothoracic surgery …………………………………….

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Chapter V –Evaluation 37Mini Clinical Examination …………………………..……………….Direct Observational Procedural Skills (DOPS) …….……………Final Examination …………………………………...……………….Professional behavior evaluation …………………………………..Scoring ………………………………………………………………..Mark conversion ……………………………………..

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………………Rules for Remedial or failed student ………….....………………..Feedback …………………………………………….……………….

References 40


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Chapter I – PrefaceProgram descriptionMedical clerkship in surgery (Program studi profesi dokter– PSPD, code C12A 001) is part of medical clerkship program in Faculty of Medicine Unpad. This is one of four major 9 weeks clerkship rotation program. In this surgery rotation, the student will learn knowledge’s and basic skills in surgery, with the hope it will fulfilled the competencies for medical doctor based on Indonesian standardized medical doctor competencies (standar kompetensi dokter Indonesia - SKDI).

Vision and MissionIn accordance with faculty of medicine's vision: To become center of education and research with superiority in the field of medicine and health, as well as holistically integrated community service, which lead to enhance the dignity of people and country. To anticipate the rapid change in the field of health science and technology, as well as new paradigm in management of higher education, faculty of medicine universitas padjadjaran reveal its mission: a. To enforce integrated medical education and health system, with the end results skilled and virtuous physician with superiority in molecular technology.b. To increase quality and quantity of health and medicine research which nationally and internationally competitive.c. To deploy and apply medical science and technology for public welfare and to enforce professional community service with a goal to increase national health

Goals of medical education in the field of surgeryGeneral Purpose (General competencies to be achieved)At the end of the rotation, the studentswill be able to diagnose surgical case generally, based on complete and accurate history taking, physical examination, as well as interpreting laboratory findings and imaging as tools to help diagnosis.The students also needs to have knowledge’s and skills to manage surgical cases, educating patients for disease prevention and rehabilitation, which is ethical and in concordant to Indonesian standard of medical doctor competencies.Able to diagnose surgical emergency and elective cases and competent to manage primary pre-hospital treatment, prior to referring the patient to surgeon; and as a general practitioner who has ability to self-enhance the surgical knowledge’s and always committed to long-


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life learning and follow on the latest development of science especially in the fields of surgery.

Specific goals (Specific competencies to be achieved)At the end of the rotation, students are expected to have abilities to:

1. Explain basic surgical science2. Determine diagnosis of surgical cases based on Indonesian

standard of medical doctor competencies (SKDI)3. Plan the management of surgery related anomalies and

disease based on SKDI4. Explain basic perioperative care5. Demonstrate appropriate non-operative clinical surgery skills6. Demonstrate appropriate basic surgery skills7. Behave professionally in patient treatment based on good

surgical practice, and apply the principles of Bioethics and Humanism.

Rotation duration and placeThe duration of clerkship rotation is 9 weeks. Rotation will be conducted fully in Hasan Sadikin Hospital (RSHS) in 1st, 2nd and 9th

week, and partially on the 3rd to 8th week combined with satellite hospital. There are three satellite hospital: Cibabat hospital, Salamun hospital, and Ujung Berung hospital. The satellite hospital placement will be determined during the rotation by coordinator.The total credits in surgery clerkship rotation are 5.

Rules and SanctionsGeneral Rules1. Prior clerkship, student already complete all the necessary

university (faculty of medicine) administration 2. Before the rotation begin, the notice letter from the faculty

clerkship coordinator should be accepted by the department clerkship coordinator and the head of department. The notice letter consist enlisted students.

3. Clerkship students will be grouped. Student must comply with the clerkship activities according to the schedule. The group and schedule will be determined by department coordinator.

4. Clerkship students must appoint a leader (namely “chief”). One week before the rotation begin, the chief should report to the clerkship coordinator and the head of department.

5. All the student must attend the first emergency report on first Monday at 07:00am in surgery conference room. After the emergency report, all student should remain in the conference


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room for short briefing with clerkship coordinator (if the conference room is vacant). The logbook and the guidebook will be distributed.

6. Working hour: Monday to Thursday: 07:00am – 04:00pm, 12:00pm – 01:00pm lunch break. Friday: 07:00am – 04:00pm, 11:30pm – 01.00pm Friday pray and lunch break.

7. All student must sign the attendance twice a day; sign in (before 07:00am) and sign out (after 04:00pm). Attendance signature must be done by him/herself, surrogacy by friend is not permitted.

8. If student need to leave duty for personal or other purposes, the student must inform the preceptor and the coordinator, and explain the reason for leaving duty.

9. For particular reason if the student unable to attend the rotation (personal matter, become ill), he/she must have a letter which explain the reason. If the reason is illness, he/she must bring the doctor reference letter the day when the student present.

10. All learning activities and clinical activities should be written in the logbook. The logbook should be signed by the preceptor, and for some activities by the resident.

11. Students must obey the academic norm and regulation, which include proper dress. The regulation is written in: Surat Keputusan Dekan No. 126/J06.6.FK/Kep/KM/2003

12. Each student must behave professionally, discipline, and obey the regulation.

13. Student are not allowed to conduct assignment from other department.

14. Student are not allowed to wear the white coat outside the hospital.

15. Student are not allowed to examine patient while carry a backpack.

Night shift rules1. Each student must have at least 18 times night shift. During

the night shift, student working as general practitioner helping surgery resident from all division or department. Student is not allowed to have night shift based on a division or sub-specialty, and only allowed to have night shift in surgery generally.Student must have night shift in Saturday or Sunday, or in public holiday. Night shift must occur even during the spacingin the middle of the rotation.

2. If the student unable to attend the night shift due to illness or personal matter, student must reschedule the lost night shift


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to other day. 3. On the working day, night shift starts at 04:00pm to 07:00am

the next day. 4. Night shift on Saturday, Sunday, or public holiday, divided into

two shift: first shift started at 07:00am – 07:00pm, and second shift at 07:00pm – 07:00am the next day.

5. If the student must leave the duty for important purpose, he/she must ask permission to the chief resident on duty.

6. If the student arrive late more than 15 minutes without any notes (preceptorship, or involved in surgery), student are not allowed to join the night shift and must reschedule the night shift on other day.

7. Student must fill the logbook 8. During the night shift student must wear night shift attire

(scrub suit). Student are not allowed to wear scrub suit outside the hospital.

9. Night shiftJockey is strictly prohibited10. The night shift consultant surgeon is the on-duty surgeon. 11.Night shift free only allowed one night before the final

examination; The last night shift is on the last Sunday which ended at 07:00pm.

Sanctions1. The maximum absent is 3 day (not necessarily consecutive).

Absent for more than 3 day (with permit letter or doctor reference) will be considered as resignation from clerkship in surgery. Student must start the clerkship from the beginning.

2. Depend on the division, preceptor might give an assignment to replace the absent day.

3. Student who is absent for more than 1 day without permit letter or doctor reference will be considered as resignation, and need to report to faculty clerkship coordinator.

4. If the student involved in indisciplinary action, against the academic norm or if the student involved in crime (including jockey), student will be expel from the clerkship and returned to the faculty clerkship coordinator.

5. Late attendance: 10-30 minutes, subjected to assignment. More than 30 minutes late will be considered not present

Exchange / Visiting Medical StudentOur department are very welcome to exchange or visiting medical student from around the world. Exchange / visiting medical student must have a recommendation letter from the home university and the faculty


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of medicine Unpad.Exchange or visiting student are not subjected to the above rules, but student with unaccepted behaviour will be ask to resign from the department.

PrecautionsHasan Sadikin is a large hospital with thousands of people in and out every day. In this matter, organize or unorganized crime by unknown people is highly possible. For your protection, please:

1. Take care of your own personal belonging. It is very common for medical staff, student, or nurses losses their personal belonging such as cell phone, tablet, laptop, or even their large backpack in extreme way. Please Do not left personal belonging unattended.

2. Please wear your identification card, and your white coat inside the hospital during working time, or your scrub suit during night shift.

3. Do not charge your electrical device in medical purpose electrical outlet (such as in emergency room, operating room, etc.), to prevent electrical shortcut.

4. Please report to the hospital security (do not directly report to the police) if you witnessing or experiencing any criminal act.

5. If you are dealing with any patients or family with aggressive behaviour or highly emotional, please do not confront it by yourself. In some circumstances, report to the security for any unaccepted behaviour

Health PrecautionIn Department of Surgery, it is very likely that you will be expose to wounded patients or performing invasive procedure to any patient. We do not know if our patient suffered from infectious disease such as TB, Hepatitis B, C, or HIV. Please always be CAUTIOUS:

1. Hepatitis B vaccination is highly recommended2. Consistent in performing Universal Precaution (UP)3. Wear a mask if there is suspected air-borne disease


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Chapter II – StaffChairHead of Department Dr. Dimyati Achmad, dr., SpB(K)Onk Head of Surgical Residency Program Dr. Kiki Lukman, dr., SpB-KBD.

Staff and its division and departmentDigestive SurgeryHead of division Maman Wastaman Rodjak, dr., SpB-KBDStaff Nurhayat Usman, dr., SpB-KBD., FINACS Haryono Yarman, dr., SpB-KBD Dr. Reno Rudiman, dr., SpB-KBD., M.Sc Dr. Kiki Lukman, dr., SpB-KBD., M.Sc Bambang A.Sulthana., dr., SpB-KBD Andriana Purnama., dr., Sp.B-KBD Tommy Ruchimat, dr., SpB-KBDSurgical OncologyHead of divisionFransisca Badudu, dr., SpB(K)OnkStaff Dr. Dimyati Achmad, dr., SpB(K)Onk Monty P. Soemitro, dr., SpB(K)Onk Maman Abdurahman, dr., SpB(K)Onk Kiki Ahmad Rizki, dr., SpB(K)Onk Raden Yohana, dr., SpB(K)OnkPediatric SurgeryHead of Division Bustanul Arifin. N., dr., SpB., SpBA Staff Dikki Dradjat K, dr., SpB., SpBA Rizky Diposarosa, dr., SpB., SpBA Arhans Chairul, dr., SpBA., MKes Vita, dr., SpBAUrologyHead of Division Dr. Bambang Sasongko Nugroho, dr., SpB., Sp.U


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Staff Prof. Dr.Suwandi Sugandi, dr., SpB., Sp.U Tjahjodjati, dr., SpB., Sp.U Dr. Ferry Safriadi, dr. SpU Ricky Ardiansyah, dr., Sp.U Safendra, dr., Sp.U Kuncoro Adi, dr., Sp.U Aaron Tigor Sihombing, Sp.U Jupiter Sibarani, dr., SpU Sawkar Vijay Pramod, dr., SpU

Vascular SurgeryHead of Division Prof. Dr. Hendro Sudjono Yuwono, dr., SpB-(K)V.Staff Teguh Marfen Djajakusumah, dr., SpB-(K)V., Mkes Putie Hapsari, dr., SpB

Cardiothoracic SurgeryHead of Division Rachim Sobarna, dr., Sp.B., Sp.BTKV(K)Staff Dr.Tri Wahyu, dr. Sp.B. Sp.BTKV(K)., M.Hkes Rama Nusjirwan, dr., Sp.BTKV Euis Maryani, dr., Sp.B

Plastic SurgeryHead of Division Hardi Siswo, dr., SpBP Staff Lisa Y. Hasibuan, dr., SpBP Irra Rubianti, dr., SpB., SpBP(K)RE Ali Sundoro, dr., SpBP

Department of NeurosurgeryHead of Department Dr. M. Zaffrullah Arifin, dr., SpBS(K)Staff Ahmad Imron, dr., SpBS Ahmad Adam, dr., SpBS Roland Sidabutar, dr., SpBS Firman Priguna Tjahjono, dr., SpBS Rully Dahlan, dr., SpBS Myrna Sobarna, dr., SpBS


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Department of Orthopaedic and TraumatologyHead of Department Nucki N. Hidajat, dr., SpOT(K)., FICS., M.KesStaff Prof. Dr. Darmadji Ismono, dr., Sp.B., SpOT(K)., FICS Bambang Tiksnadi, dr., Sp.B., SpOT(K).,FICS., Rizal Chaidir, dr., Sp.OT(K).,FICS.,M.Kes Dr. Hermawan N. Rasyid, dr., SpOT(K)., FICS Prof. Dr. Fachry A.Tandjung, dr., Sp.B., SpOT(K)., FICS Dr. Agus H. Rahim, dr., SpOT(K)., FICS Dicky Mulyadi, dr., SpOT(K)., FICS Yoyos D. Ismiarto, dr., SpOT(K)., FICS Faturrachman, dr., MKes., Sp.OT Widya Arsa, dr., Sp.OT Ahmad Ramdan, dr., Sp.OT Naseh, dr., SpOT Andri Primal, dr., SpOT Herry Herman, dr., PhD., SpOT

Medical student affairsCoordinator : Teguh Marfen Djajakusumah, dr., Sp.B-(K)V., MkesSub-coordinator: Rizky Diposarosa, dr., SpB., SpBA

Rama Nusjirwan, dr., Sp.BTKVSecretary : Dicky Maulana

FacilitiesFacilities in Department of Surgery:1. Conference room “R. Koestedjo”, commonly used for emergency

report, journal reading, case report, lecture for medical student2. Internet through Wi-Fi 3. Discussion room in each division4. Learning facilities: Surgery clinics (9 clinics division and 1 general

surgery clinic), Surgery Wards (“Kemuning”, “Kana”, “Anthurium”, and “Aglonaema”), Central Operating Theater (Emergency, Elective and One-Day Surgery) and Emergency Room

5. Sattelite Hospital (Salamun, Cibabat, and Ujung Berung Hospital)


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Chapter III –Subject and MatterExpected Competencies(Based on Standard of Indonesian Medical Doctor Competencies or Standar Kompetensi Dokter Indonesia - SKDI)Basic Surgical Knowledges Competencies1. Able to explain type of minor surgery 2. Able to explain type of major surgery 3. Able to explain informed concent4. Able to explain universal precaution andinfection prevention5. Able to explain local anesthesia technique 6. Able to explain maximum dose of local anesthetic agent 7. Able to explain basic surgical skills which includeknotting,

suturingand instrumenthandling.8. Able to explain the type of suture material for wound suturing, both

inside or outside of the wound. 9. Able to explain the type and purpose of wound suturing technique 10. Able to explain each surgical instrument for minor surgery and its

purpose 11. Able to explain wound healing process and factors that influence

wound healing Psychomotor Competencies1. Demonstrate the process of good informed consent2. Demonstrate the process of universal precaution and infection

prevention3. Demonstrate the process of applying local anesthetic4. Demonstrate the process of choosing the appropriate suture

material 5. Demonstrate the process of choosing the appropriate surgical

instrument for suturing 6. Demonstrate the process of wound suturing, and able to choose the

appropriate suturing technique 7. Demonstrate the process of wound care and management 8. Demonstrate the process of giving medical education to the patient

about wound care

Competencies based on Scope of Subject Expected level of competencies (according to SKDI) The Indonesian Standard of Medical Doctor Competencies divide the competencies based on scope of subject: Level 1 to 4

Level of Competency 1: recognize and explainGraduated student able to recognize and explain the clinical appearances of a disease and know how to gain appropriate further information about the disease, as well as determination of further


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appropriate referral

Level of Competency 2: diagnosis and referralGraduated student able to determine the correct clinical diagnosis of a disease and able to determine the appropriate referral to relevant specialist. Graduated student must be able to execute the process afterward.

Level of Competency 3: diagnosis, initial management, and referral3A. Non-emergency caseGraduated student able tomanage a disease in non-emergency situation and able to give initial treatment in order to save life or to avoid worMondayg of the disease, or to avoid permanent disability. Graduated student must be able to determine further correct referral for further appropriate treatment, and able to execute the process.

3B.Emergency caseGraduated student able to conduct initial emergency treatment and able to give early therapy to save life or to avoid worsening of the disease, or to avoid permanent disability. Graduated student must be able to determine further correct referral for further appropriate treatment, and able to execute the process.

Level of Competencies 4: diagnosis and complete independent treatmentGraduated student able to completely treat the disease independently. Graduated student must be able to determine the correct diagnosis based on physical examination, laboratory findings or simple imaging such as x-ray, appropriately and not overly.

In Department of Surgery Hasan Sadikin Hospital, surgery is divided to 7 division, and 2 independent department (there is no division of general surgery). Student would be distributed to 9 division, and the listed competencies on SKDI will be distributed according to division as well. In department of surgery, local content (which is not listed on SKDI) will be added.

Competencies based on Clinical SkillsExpected level of clinical skills competencies (SKDI)According to SKDI, clinical skills competencies are divided to 4 levels, based on the Miller’s pyramid (knows, knows how, shows, does);

Level of competencies 1: Knows and able to explain


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Graduated student must have theoretical knowledges of a medical skill, and able to explain the procedural skills to friend, colleague, patient, or client about the concept, theory, principles, and indication, as well as how to do it, the possible complications, etc.

Level of competencies 2: Knows how; had seen or demonstratedGraduated student must have theoretical knowledges of a medical skill (including concept, theory, principle, indication, how to do it, complications, etc.). Graduated student had seen the medical skill or had others demostrated the medical skill directly applied to patient.

Level of competencies 3: Shows; had performed or applied the skillunder supervision Graduated student must have theoretical knowledges of a medical skill (including concept, theory, principle, indication, how to do it, complications, etc.) as well as mastering the bioethical background and psychosocial impact. Graduated student had seen, demonstrated, and performed or applied the medical skill to real patient under supervision, and practice the medical skill to a model or standardized patient.

Level of competencies 4: Does; perform the skill independently Graduated student can demonstrate his/her ability to perform a medical skill by mastering the whole theories, principles, indications, procedural steps, complications and how to deal the complications. Had performed the medical skill under supervision.

4A: Achieved the medical skill after graduation4B: Achieved the medical skill after internship or obtain the skill by post graduate course.

Scope based on competencies (SKDI) and local content (*) according to division,And clinical skills competencies

Levelof

competencyNote: yellow color indicate as possible as national OSCE caseLevel 1 or 2 could be use for CSS or CRS topicsVascular surgery:Arterial disease1. Abdominal Aortic Aneurysm (AAA) 12. Aortic dissection 13. Peripheral Artery Disease

- Diabetic foot * -- Thromboangiitis obliterans (Buerger’s disease) 2- Raynaud’s syndrome 2


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- Arterial thrombosis 2- Arterial embolism 1- Claudication 2- Lower extremity ulcer 4A

Venous disease4. Varicose vein 25. Chronic Venous Insufficiency 3A6. Deep Vein Thrombosis 27. Venous embolism 28. Thrombophlebitis 3ALymphatic disease9. Lymphangitis 3A10. Lymphedema

Primary Secondary (elephantiasis - filariasis)

3A

Vascular anomalies6. Infantile Hemangioma 27. Vascular malformation*

Venous malformation Capillary malformation Lymphatic malformation (limfangioma) Arteriovenous malformation (AVM)

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List of Clinical Skills:Carotid artery palpation 4APalpation of peripheral arterial pulses 4ACapillary refill time 4ADetection of bruit 4ABrodie Trendelenburg test 4APerthes test 3Reactive Hyperemia test for arterial insufficiency 3Postural test for arterial insufficiency 3Homan’s test 3Ankle-brachial index 3Doppler ultrasound 2Venous puncture 4AArterial puncture 3Finger prick 4AVenous cutdown 3Pediatric venous cutdown 3

Cardiothoracic surgery:


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Thoracic disease1. Lung cancer 22. Pleural Effusion 23. Massive pleural effusion 3B4. Pneumothorax 3A5. Tension pneumothorax 3A6. Atelectasis 27. Lung abscess 3A8. Hematothorax 3B9. Mediastinal tumor 210. Rib fracture (includingflail chest) * -11. Lung contussion * -12. Thoracic Empyema * -13. Open thoracic surgery on TB * -Cardiac disease9. Acquired* (CABG surgery, Valve surgery)

Congenital* (Cyanotic: Tetralogy of Fallot, Non-cyanotic: ASD, VSD, PDA)

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List of Clinical Skills:Respiratory inspection 4AChest inspection 4AChest auscultation 4AChest percussion 4AChest palpation 4APleural tap 3Superficial FNAB 2Trans thoracal needle aspiration 2Needle decompression 4AChest tube insertion 3Water Sealed Drainage (WSD) care 4APleural puncture 3Oxygen therapy 4A

Digestive surgery:Abdominal wall1. Reponible and ireponible hernia (inguinal,

femoral, scrotal)2

2. Incarcerated or strangulated hernia 3B3. Umbilical hernia 3BAcute abdomen4. Acute appendicitis 3A5. Appendicular abscess 3B


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6. Peritonitis, due to: Perforated appendix, typhoid, gastric Other source of perforation

3B

7. Gastrointestinal bleeding 3B8. Chole(docho)lithiasis 29. Acute Cholecystitis 3B10. Pancreatitis 211. Ileus (bowel obstruction) 212. Obstructive jaundice * -Colorectal13. Diverticulosis, diverticulitis 3A14. Colitis 3A15. Colorectal cancer 216. Rectal, anal prolapsed 3A17. Hemorrhoids grade 1-2 4A18. Hemorrhoids grade 3-4 3A19. (peri)anal abscess 3A20. Perianal fistula 221. Anal fissure 2Others22. Amebic liver abscess 3A23. Tetanus 3B24. Snake or animal bites * -25. Hipovolemic shock (bleeding) 3B26. Trauma abdomen * -List of Clinical Skills:Abdominal inspection and palpation 4AGroin inspection and palpation 4AHernia palpation 4APsoas sign and obturator’s sign 4ADigital rectal examination 4ANasogastric tube insertion 4AEndoscopy 2Nasogastric tube suction 4AColostomy bag replacement 4AEnema 4AAnal swab 4AGastroscopy 2Proctoscopy 2Ascites sampling 3Abdominal ultrasound 2


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Pediatric surgery1. Intussuception / Invagination 3B2. Anal Atresia (anorectal malformation) 23. Fistula umbilical, omphalocele,gastroschizis 24. Billiary Atresia 25. Intestinal Atresia 26. Esophageal Atresia 27. Hirschsprung’s disease 28. Hydrocele 29. Reponible and ireponible hernia (inguinal,

femoral, scrotal)2

10. Incarcerated or strangulated hernia 3B11. Umbilical Hernia 212. Undescended testis 213. Phymosis 4A14. Paraphymosis 4A15. Cystic hygroma 216. Hypospadia 2List of Clinical Skills:History taking from third party, or older children, or anxious parents

4A

General pediatric physical examination 4ACongenital malformation observation 4APediatric peripheral IV cannulation 4APediatric intubation 3Oropharynx tube insertion 2Intraosseus cannulation 2Circumcision 4AAirway, breathing management 3Emergency rehidration 4A

Plastic surgery1. Cleft lip and Palate 22. Angina ludwig 3A3. Lacerated wound 4A4. Perforated, penetrated wound 3B5. Maxillofacial trauma * -6. Peritonsillar abscess 3A7. Hidradenitis supurativa, carbuncle 48. Ingrowing toenails 49. Ganglion cyst 410. Lipoma 4A


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11. Burn, 1st and 2nd degree 4A12. Burn, 3rd degree 3B13. Burn, chemical 3B14. Burn, electrical 3BList of Clinical Skills:Infiltration anesthesia 4ALocal nerve block 4ATopical anesthesia 4AWound suturing 4ASuture removal 4AAnalgesic administration 4AIncision and drainage of abscee 4AExcision of benign skin tumor 4AWound care 4ARozerplasy 4ABandaging 4A

Urology1. Benign Prostatic Hyperplasia 22. Urethral rupture 3B3. Bladder rupture 3B4. Kidney rupture 3B5. Torsion of Testis 3B6. Urethral stricture 3A7. Varicocele 28. Hydrocele 29. Urinary stone disease or urinary calculi 3A10. Priapism 3B11. Renal colic 3A12. Asymptomatic urinary tract stone disease 3A13. Urinary tract infection 4AList of Clinical Skills:Bimanual kidney examination 4ACostovertebral angle tenderness examination 4ABladder palpation 4AProstate palpation 4ABulbocavernous reflex 3Uroflowmetry 1Plain abdomen and IVP x-ray interpretation 3Urethral catheterization 4AClean intermitten catheterization 3Suprapubic puncture 3


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Circumcision 4APenis, scrotum inspection and palpation 4AScrotum transilumination test 4A

Surgical OncologyBreast disease1. Breast cancer 22. Phyllodes tumor 13. Fibroadenoma of the breast 24. Mastitis 4A5. Breast abscess 26. Paget’s disease of the breast 17. Cracked nipple 4A8. Inverted nipple 4AThyroid disease9. Goitre 3A10. Thyroid adenoma 211. Thyroid cancer 2Skin disease12. Nevus pigmentosus 213. Malignant melanoma 114. Squamous cell carcinoma 215. Basal cell carcinoma 2Others16. Non-Hodgkin’s lymphoma 117. Hodgkin’s lymphoma 118. Other soft tissue tumors: fibrosarcoma,

rhabdomyosarcoma, leimyosarcoma1

19. Branchial cyst and fistula 220. Tumor lidah * -21. Tumor rongga / dasar mulut * -22. Lymphadenopathy 3A23. Lymphadenitis 4AList of Clinical Skills:General and Breast Examination 4ASelf-Breast examination education 4AThyroid palpation 4AAxillary lymphatic node palpation 4ASalivary gland palpation 4ALymph node examination 4A

Orthopaedic surgery


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Trauma1. Open fracture, close fracture 3B2. Clavicle fracture 3A3. Pathologic fracture 24. Fracture and disclocation of vertebrae 25. Extremity disclocation 26. Join trauma 3A7. Achilles rupture 3ADegenerative8. Osteoarthritis 3A9. Osteoporosis 3A10. Spondilitis 2Others11. Primary and secondary bone tumor 212. Osteomyelitis 3B13. Congenital malformation 214. Carpal tunnel syndrome 3A15. Tarsal tunnel syndrome 3AList of Clinical Skills:Gait inspection 4ASupine-backbone inspection 4AMoving-backbone inspection 4AExtremity muscle tone inspection 4AExtremity join inspection 4AInspection of backbone and pelvic postural 4AInspection of scapular position 4AInspection of spine flexion and extension 4AAssesment of lumbal flexion 4AAssesment of flexion, extension, adduction, abduction and rotation of Hip

4A

Assesment of muscle atrophy 4AKnee: Assesment of cruciate and lateral ligament 4AMeniscus evaluation 4APostural and shape inspection of foot 4ADorsal and plantar flexion, inversion, eversion of foot 4APalpation for tenderness 4APalpation for detection of vertical pressure pain 4APalpation of tendon and join 4ABack bone and muscle, sacro-iliac join palpation 4APercussion for tenderness 4AEvaluation of join ROM (Range Of Motion) 4AEvaluation of Head ROM 4A


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Shoulder join and muscle function test 4AWrist, metacarpal, finger join function test 4ALeg discrapency examination 4AClose fracture reposition 3Fracture stabilisation (without casting) 4AReduction of dislocation 3Application of Dressing (Sling, bandage) 4AJoin aspiration 2Splinter removal 3

NeurosurgeryTrauma1. Epidural hematoma 22. Subdural Hematoma 23. Spinal cord injury 24. Complete spinal transection 3BOthers5. Hydrocephalus 26. Hernia of Nucleus Pulposus (HNP) 3A7. Spondylitis TB 3AList of Clinical Skills:Glasgow Coma Scale examination 4AVertebral inspection, percussion, and palpation 4ASkull x-ray interpretation 4AVertebral x-ray interpretation 4AHead CT-Scan and interpretation 2

List of general Clinical Skills:Skin test 4ABlood test examination 4APlain x-ray interpretation 4AContrast x-ray interpretation 3Minor surgery prep: a and antiseptic, local anesthesia 4AObserver or assistant in major surgery: Scrubbing, Gowning, Gloving

4A

Patient transport 4ABasic life support 4AMask ventilation 4AIntubation 3Fluid resuscitation 4A

Clinical Skills in pre-clerkship phase


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Some of expected clinical skills competencies had been given during skills lab activities in pre-clerkship phase. Some of the skills are not listed in SKDI’s clinical skills, but considered as important skills for medical student.List of clinical skills:

1. Airway and ventilatory management2. Breathing; ventilation and oxygenation3. Circulation with hemorrhage control4. Oropharingeal and nasopharingeal airway insertion5. Respiratory history taking and physical examination in adult6. Oxygen therapy in adult and pediatric7. Needle thoracostomy8. Breast and axilla examination9. Infection prevention

Hand washing Surgical scrubbing Gowning Gloving Antiseptic technique Equipment treatment

10. History taking and physical examination in patients with thyroid disease

11. History taking and physical examination of acute abdomen12. Nasogastric tube insertion13. IV catheter insertion14. History taking and physical examination of jaundice patient15. History taking and physical examination of groin lump16. Digital Rectal Examination17. Urinary catheterization18. Suprapubic puncture19. Circumcision20. History taking and physical examination in orthopaedic21. Wood splinting and bandaging22. Skin traction23. Wound toilet and debridement of open fracture24. Basic Surgical Skill’s

BSS instrument and knotting Local anesthesia Suturing Minor surgery

Chapter IV - Routine activitiesClerkship Duration:


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The duration of clerkship in surgery is 9 weeks; mostly in Hasan Sadikin hospital, and 3 weeks in sattelite hospital. The clerkship in sattelite hospital will be placed in the week of division rotation (2 or 3 days of 5 days in division).

Learning and teaching method:Preceptorship:

BST (Bed Side Teaching): the teaching of a case will be conducted by the preceptor with the patient involvement. Teaching process can be carry out in ward, outpatient clinic, emergency room, or operating room.

CRS (Case Report Session): is an applied Problem Based Learning. Student search for an interesting or challenging real common case within general practitioner competency (listed on competencies list above), and presented to the preceptor. After the presentation, the preceptor will lead a discussion with students, to find problems and solutions for the case.

CSS (Clinical Science Session): student presented a science matter, such as journal, rare case, difficult case, basic science, or current theory for a surgical disease. The topic could be beyond general practitioner competency (advance) or level 1 or 2 SKDI, and discuss it with the preceptor.

General activities Meet the expert: General lecture by consultant surgeon. During

the lecture students are free to ask the surgeon (open discussion). Lecture will be held on Tuesday or Thursday at 08:00am in conference room.

Emergency morning report: student must attend the morning report every Monday, Wednesday, and Friday at 07:00am. Emergency morning report will be lead by consultant surgeon and presented by general surgery resident. In emergency report, student will learn from the presented case, and sees the discussion and debate for emergency case management. Every Wednesday, the official language for emergency report is English.

Journal reading: senior resident will presents current journal, and then discuss or criticize the journal (critical appraisal of the topic). Journal reading will be conducted after emergency report, every Wednesday (in english) or Friday, started around 08:00-08:30am.

Supervision and teaching by resident:As part of the curriculum, resident in surgery have obligation to


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supervize and teach medical student. The main position of resident is as an assistant to consultant or preceptor, and has a full right in medical student education.There are some activities conducted by resident:

Scheduled mini-lecture or skills lab Daily discussion in ward, clinic, operating room or emergency

room, or in sattelite hospital (not all sattelite hospital has resident)

Daily activities supervisionThe resident will also act as consultant or preceptor assistant, when the preceptor unable to supervized, teach, or lead discussion with the student for some important reason.The final semester resident will also get involved in student’s final examination (OSCE) as a bystander.Resident have a medical student’s coordinator, which will appointed a resident as supervisor for each student group. The supervisor resident will monitor the education process of each group, teach the medical student, and reporting problem to coordinator.

Weekly activitiesDepartment of surgery is unique; each 7 division is more like an independent department, and the 2 are actually departments. Each preceptor in division or department has different specialty background (not all preceptors have general surgery background). The preceptor also has limited access to patient which is not within his/her division. To comply with the condition, students need to be grouped and distributed to 9 divisions / departments; the preceptor will also divided according to the division / department. Each week, the group will rotate to another division / department, and will have different preceptor following the division / department.

In the 3rd or 4th week of rotation, all students will take turns to sattelite hospital. Each group in division will be divided half; in the first 3 day the first half will be in sattelite hospital, and the last 2 days will be in Hasan Sadikin, and vice versa.Note: in sattelite hospital, the working day is 6 days a week. Students who are in the sattelite hospital in the last 2 days must present in the sattelite hospital in Saturday (3 days in sattelite hospital).

The preceptor will at least meet the student 2 hours a day for BST, CRS, or CSS. The meeting with preceptor should be with an appointment or scheduled. It is mandatory for student to have preceptor’s contact


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number.

Place of activitiesLearning activities will be conducted in each division / department; student must adhere to each division / department schedule (except for general activities such as emergency report).

Weekly schedule for each Division / Department

Division of Digestive SurgeryDay Time Activities Place


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Mo 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-12 Daily activities Clinic or OR12-13 Break13-15 BST Preceptor15-06 Night shift ER

Tue 06-07 Resident round Ward07-08 Resident presentation Digestive room08-09 Patients parade Digestive room09-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Resident case report Digestive room09-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Grand round Kemuning L. 408-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER

Fri 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-11 Daily activities Clinic or OR11-13 Break, Friday pray13-15 Daily activities Clinic or OR15-09 Night shift ER

Division of Oncology SurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-09 Patients parade Onkology room


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09-10 Grand round Kemuning L. 310-12 Daily activities Clinic or OR12-13 Break13-15 BST Preceptor15-06 Night shift ER

Tue 06-07 Resident round Ward07-08 Referat Residen Konfrens Onkologi08-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Residen presentation Onkology room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER


Division of Pediatric SurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-09 Resident presentation Pediatric Surgery room09-12 Daily activities Clinic or OR


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12-13 Break13-15 BST Preceptor15-06 Night shift ER

Tue 06-07 Resident round Ward07-08 Pediatric EMG Report Pediatric Surgery room08-09 Resident presentation Pediatric Surgery room09-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Resident presentation Pediatric Surgery room09-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 PatientsParade Pediatric Surgery room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER

Fri 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Grand round Kemuning L. 209-11 Daily activities Clinic or OR11-13 Break, Friday pray13-15 Daily activities Clinic or OR15-09 Night shift ER

Division of Plastic SurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-12 Daily activities Clinic or OR12-13 Break


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13-15 BST Preceptor15-06 Night shift ER

Tue 06-07 Resident round Ward07-08 Plastic EMG report Plastic surgery room08-09 Case report Plastic surgery room09-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Referat Residen Plastic surgery room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER

Fri 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Patients parade Plastic surgery room09-11 Grand round Kemuning L. 411-13 Break, Friday pray13-15 Daily activities Clinic or OR15-09 Night shift ER

Division of UrologyDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-09 Patients parade Urology room09-12 Daily activities Clinic or OR


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Tue 06-07 Resident round Ward07-08 Urology EMG report Urology room08-09 Patients parade Urology room09-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Patients parade Urology room09-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Grand round Kemuning L. 408-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER


Division of Vascular SurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-10 Science session Vascular surgery room10-12 Daily activities Clinic or OR


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12-13 Break13-15 BST Vascular surgery room15-06 Night shift ER

Tue 06-07 Resident round Ward07-10 Science session Vascular surgery room10-12 Daily activities Clinic or OR12-13 Break13-15 CSS Vascular surgery room15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-10 Science session Vascular surgery room10-12 Daily activities Clinic or OR12-13 Break13-15 CRS Vascular surgery room15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Science session Vascular surgery room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Vascular surgery room15-06 Night shift ER

Fri 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-10 Science session Vascular surgery room10-11 Daily activities Clinic or OR11-13 Break, Friday pray13-15 Science session Vascular surgery room15-09 Night shift ER

Division of Orthopaedic SurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-09 Resident presentation Orthopaedic room09-12 Daily activities Clinic or OR


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Tue 06-07 Resident round Ward07-08 Orthopaedic EMG report Orthopaedic room08-10 Grand round Anthurium/Aglonaema10-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Science session Orthopaedic room09-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Orthopaedic EMG report Orthopaedic room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER


Division of NeurosurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-10 Science session Neurosurgery room


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10-12 Daily activities Clinic or OR12-13 Break13-15 BST Preceptor15-06 Night shift ER

Tue 06-07 Resident round Ward07-10 Science session Neurosurgery room10-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-10 Science session Neurosurgery room10-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Science session Neurosurgery room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER

Fri 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Grand round NCCU09-11 Daily activities Clinic or OR11-13 Break, Friday pray13-15 Daily activities Clinic or OR15-09 Night shift ER

Division of Cardiothoracic SurgeryDay Time Activities PlaceMon 06-07 Resident round Ward

07-08 Emergency report Koestedjo room08-09 Patients Parade Cardiothoracic room


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09-10 Grand round Ward10-12 Daily activities Clinic or OR12-13 Break13-15 BST Preceptor15-06 Night shift ER

Tue 06-07 Resident round Ward07-09 Resident presentation Cardiothoracic room09-12 Daily activities Clinic or OR12-13 Break13-15 CSS Preceptor15-06 Night shift ER

Wed 06-07 Resident round Ward07-08 Emergency report Koestedjo room08-09 Grand round Ward09-12 Daily activities Clinic or OR12-13 Break13-15 CRS Preceptor15-06 Night shift ER

Thu 06-07 Resident round Ward07-08 Resident presentation Cardiothoracic room08-09 General Lecture Koestedjo room09-12 Daily activities Clinic or OR12-13 Break13-15 Mini-Cex Preceptor15-06 Night shift ER


Chapter V – EvaluationStudent’s evaluation will be regularly conducted in the form of BST, CRS, CSS, and Mini-Cex or DOPS (Direct Observation of Procedural Skills) by preceptor each meeting time.

Mini Clinical ExaminationMini Clinical Examination (Mini-Cex) evaluation will be conducted by


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each preceptor each meeting session with the student. Mini-Cex rules:

Mini-Cex only allowed to be conducted after student had done the BST, CRS, and CSS.

All student must have Mini-Cexonce by the preceptor Timing or schedule for Mini-Cex determined by the preceptor

Mini-Cex procedure:1. Preceptor determine the Mini-Cex material and case2. The case for examination will be a real case, and it could be

taken from clinic, ward, or emergency room. The case will be within SKDI competency.

3. Preceptor will observe and score the student4. Each student has at least 20 minutes to complete the Mini-Cex,

and after the Mini-Cex student will have feedback from preceptor.

5. Preceptor will observe and score the following activities: a. History takingb. Physical examinationc. Humanism and professionalismd. Decision in clinical diagnosise. Skills and educationf. Efficiency and Organizationg. General clinical competency

6. Preceptor may give an assignment after the examination

Direct Observation of Procedural Skills – DOPSDOPS is an evaluation technique by observing directly student’s performance, focusing on core skill, by the time the student performing a procedural skill.The DOPS will focusing on “snapshot” of the most important skill, and not all elements of the skill will be scored.Preceptor will observe student during daily activities, when student performing certain procedural skill in the clinic, ward, or ER, and directly score it. Preceptor will observe and score the following activities (depend on the case):

Appropriateness of the selected procedure Explaining and giving consent to patient Administering safe analgesic or sedation Skills performance Professionalism during the procedure Clinical judgment Ability to manage complication Ability to interpreting diagnostic tools information


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Planning disease management Counseling or communication of the treatment result

Final examinationDuring the final week, all student will be posted back in Hasan Sadikin Hospital for the final examination preparation. Depend on budget availability, the final examination could be in the form of OSCE (Objective Structured Clinical Examination)orClinical Examination (similar format with Mini-Cex); to comply with the National Board Examination demand. OSCE will be conducted on Tuesday, Wednesday, or Friday in the final week.Requirement for OSCE: Completed at least 8 preceptorship Completed the satellite hospital rotationOSCE rules:1. OSCE consist of 9 station; student will not go to all station, but only

3 station. Each station has different case, and the station will be selected randomly.

2. The duration of each station is 15 minutes3. OSCE case is daily case and based on SKDIDuring OSCE, bystander resident will assist and help the examiners.

Evaluation of Professional BehaviorThis evaluation is not an examination, but is a part of education. The evaluation will be conducted everyday by behavior observation. The observation will be conducted by resident, nurses, preceptor, and other consultant. Behavior to be evaluated:

1. Altruism, Caring, Compassion2. Respect, Cultural Competence3. Honesty, Honor, Integrity4. Excellence & scholarship5. Dutifulness & Responsibility6. Communication

Evaluation and ScoringActivities Weighted(%) Explanation1. Scores by preceptor 50% Cumulative of 9

preceptors- BST 30- CRS 25- CSS 25


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- Mini-Cex or DOPS 10- Others 10 Behavior, attitude,

ethics, discipline (absent), night shift

2. Final Examination 50% OSCELogbook * *Logbook (filled) is a

requirement for judiciumProfessional behavior * *Observed Behaviors.

Some unaccepted behavior will affect the judicium

Total 100%

Final score consist of cumulative of 9 preceptors score (BST, CRS, CSS, Mini-Cex), final examination, attitude, as following:

Final score: Scores from 9 preceptors (BST, CRS, CSS, MC, LL) summed and averaged + supervisor score (PS) + OSCE scores (UA)

Score: [ ∑ (BSTx0.3 + CRSx0.25 + CSSx0.25 + MCx0.1 + LLx0.1)/9] x 0.7 + PS x 0.2 + UA x 0.1

Scores conversionScore Value

80 – 100 A76 – 79 B++72 – 75 B+68 – 71 B

< 68 CStudent will be considered PASS if the score is 68 or above (B)

Rules for remedial or failed student Student who failed by one of preceptor in one division due to low score (not violation of the rule), must have re-mentoring or repeat the rotation in the division that failed. The student may repeat the rotation in the next available one week-spacing. Student must report to clerkship coordinator that he/she want to repeat the rotation.

Student who failed the OSCE, may join the remedial on the next group


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OSCE schedule. There will be no extra OSCE for failed student due to the limited time and resources.

Student who failed in more than 2 division and one of OSCE will be considered generally failed and must repeat the whole rotation in the whole division (9 weeks)

Student with problems (rules violation, ethical and professionalism violation), will be punish. The type of punishment depend on the severity of violation and will be determine in the staff meeting

FeedbackIn the last rotation day, students will be ask to fill a feedback form. Please help us to improve the clinical clerkship in surgery by participating to fill in the feedback form. The form is anonym (we don’t know who write the feedback). Please be honest when filling the form; there will be no punishment for telling something bad or negative about the education process.References

1. 2. Schwartz’s Principles of surgery, 9th Ed., McGraw-Hill’s, 2010.2. Standard Kompetensi Dokter Indonesia KKI, 2012

Teguh Marfen Djajakusumah – 2013


Guide Book April 2014

Documents

Transcript of Guide Book April 2014