Background: The care of surgical patients is becoming more complex as patients with increasing age and medical comorbidities are undergoing both elective and emergent surgeries. Studies have shown that the effective use of hospitalists can improve and standardize care of surgical patients. Since this co-management strategy is becoming more prevalent in the inpatient setting, medical students may benefit from early exposure. Our hospital created a novel Trauma Acute Care Surgery Medicine Co-Management elective for third year medical students. The goal of the elective is to foster personal and professional development of students in this specific area of interest outside the standard curriculum.
Purpose: To provide medical students on their third year inpatient internal medicine clerkship the opportunity to experience Trauma Acute Care Surgery Medicine Co-Management and to develop an innovative curriculum that enhances their educational experience.
Description: Our “Trauma Acute Care Surgery Medicine Co-Management Elective” began in June of 2018. To date, ten third-year medical students have completed the two-week elective during their internal medicine clerkship. The core clinical components of the elective are the initial medical evaluation and subsequent co-management of complex surgical patients, mostly comprised of the geriatric population with multiple co-morbid medical conditions. The most common admitting diagnoses that were co-managed are rib and pelvic fractures, intracranial hemorrhage, as well as acute surgical diagnoses, such as cholecystitis and small bowel obstruction. Students attend daily interdisciplinary rounds with the surgical team and hospitalist attending, independently evaluate patients, and receive direct 1:1 supervision with feedback by an attending hospitalist during the rotation. Students also play a role in streamlining transitions of care to the outpatient setting by enhancing communication with primary providers. Of the ten students that rotated on the elective, all submitted formal evaluations of the experience. 90% of the students reported that they were given sufficient autonomy to evaluate patients and they had ample opportunity to present differential diagnoses as well as diagnostic and therapeutic plans. 90% of the students also reported the faculty supervisors were accessible and effective teachers. Students also commented that having direct exposure to the attending enhanced their learning experience and the elective was a good transition from an inpatient general medicine to surgical rotation.
Conclusions: We believe that early clinical exposure for third year medical students within a co-management elective, combined with strong mentorship from the medicine faculty maximizes their learning experience, improves their performance, and is essential in fostering an interdisciplinary approach to care. The literature regarding co-management electives for medical students is sparse but may be an experience worth cultivating for learners interested in careers in hospital medicine.