Principles of Surgery

B3.03 Supervised clinical practice experiences must enable all students to meet the program’s learning outcomes for: 

1. preventive patient encounters
2. acute patient encounters
3. chronic patient encounter

B3.04 Supervised clinical practice experiences occur in the following settings: 

1. operating room

B3.06 Preceptors for supervised clinical practice experiences enable students to meet program-defined learning outcomes for: 

1. surgery, including pre-operative, intra-operative, and post-operative care

_{(B1.03e, B3.05a-f)}

Upon completion of the course, students will be able to:

Medical Knowledge

LO1.1 Demonstrate comprehensive medical knowledge for all organ systems pertinent to patients presenting to the surgical clinic/service.

LO1.2 Integrate knowledge of pathophysiology and disease mechanisms to diagnose and manage patient conditions effectively.

LO1.3 Recommend medications based on indication, patient profile, potential adverse effects, and drug interactions as appropriate.

Interpersonal Skills

LO2.1 Demonstrate effective communication skills to build rapport with patients.

LO2.2 Collaborate effectively with healthcare team members in the delivery of patient-centered care.

LO2.3 Demonstrate cultural humility by providing respectful care to patients from diverse backgrounds.

Clinical and Technical Skills

Clinical Skills

LO3.1 Elicit a thorough history based on the surgical patient’s chief concern or clinical presentation.

LO3.2 Perform comprehensive and problem-focused physical exams based on the patient’s chief concern.

LO3.3 Verbally communicate relevant findings of the history and physical exam to the preceptor.

LO3.4 Document care of the patient in the form of a problem focused note.

LO3.5 Interpret diagnostic studies to effectively support clinical decision-making and enhance individualized patient care.

Technical Skills

LO3.6 Demonstrate proper suturing technique.

LO3.7 Demonstrate proper scrubbing, gowning and gloving technique in the operative setting. 

LO3.8 Demonstrate sterile technique in the operative setting.

Professional Behaviors

LO4.1 Demonstrate appropriate response to feedback and engage in a self-directed approach to learning in a clinical setting. 

LO4.2 Demonstrate appropriate professional demeanor, ethics and respect in all patient interactions.

Clinical Reasoning and Problem Solving

LO5.1 Integrate patient history and clinical data to formulate an appropriate differential diagnosis for the presenting concern or clinical presentation for a surgical patient encounter. 

LO5.2 Develop post-operative treatment plans for a patient, with emphasis on responsible pain management.

LO5.3 Recommend appropriate disposition of patients according to severity of presenting symptoms.

^(B1.03f)

Upon completion of the course, students will be able to:

Medical Knowledge

IO1.1 Identify the underlying pathophysiology of acute and chronic conditions encountered in family medicine.

IO1.2 Explain how disease mechanisms relate to presenting symptoms, physical exam findings, and diagnostic results.

IO1.3 Apply pathophysiologic principles to justify diagnostic and management decisions for primary care conditions.

IO1.4 Describe the epidemiology, risk factors, clinical presentation, and expected course of diseases across all major organ systems.

IO1.5 Differentiate c life threatening conditions based on key historical, physical, and diagnostic features

IO1.6 Summarize age specific considerations for pediatric, adult, and geriatric patients in primary care.

IO1.7 Select medications based on indication, mechanism of action, and patient specific factors such as age, comorbidities, and allergies.

IO1.8 Identify potential adverse effects and clinically significant drug–drug or drug–disease interactions.

IO1.9 Adjust medication recommendations using current evidence-based guidelines and monitoring parameters.

Interpersonal Skills

IO2.1 Use active listening, empathy, and clear language to build rapport and trust with patients.

IO2.2 Communicate effectively with interprofessional team members to coordinate patient centered care.

IO2.3 Demonstrate cultural humility by adapting communication and care approaches to respect diverse backgrounds, beliefs, and health practices.

Clinical and Technical Skills

IO3.1 Obtain a complete, accurate, and organized history tailored to the patient’s chief concern.

IO3.2 Perform a focused or comprehensive physical exam using proper technique and sequencing. 

IO3.3 Summarize and verbally present pertinent positives and negatives from the history and exam in a concise, structured format.

IO3.4 Document patient encounters using a problem‑focused note that includes assessment and plan components. 

IO3.5 Interpret laboratory tests, imaging studies, and point‑of‑care diagnostics to support clinical decision‑making.

IO3.6 Demonstrate proper preparation, technique, and patient counseling when administering vaccines in a primary care setting. 

IO3.7 Follow safety protocols for vaccine storage, handling, and documentation. 

Professional Behaviors

IO4.1 Incorporate preceptor feedback into ongoing performance improvement and self‑directed learning. 

IO4.2 Demonstrate reliability by completing all course assignments, documentation, and clinical requirements by established deadlines. 

IO4.3 Maintain professional conduct, confidentiality, and ethical standards in all patient interactions.

Clinical Reasoning and Problem Solving

IO5.1 Synthesize history, exam findings, and diagnostic data to generate a prioritized differential diagnosis.

IO5.2 Develop evidence‑based treatment plans that include pharmacologic therapy, lifestyle changes, non‑pharmacologic interventions, and follow‑up recommendations.

IO5.3 Determine appropriate patient disposition, including criteria for outpatient management, urgent evaluation, or emergency referral

IO5.4 Provide clear, accurate patient education regarding diagnosis, treatment options, and preventive strategies.

IO5.5 Apply current clinical guidelines to make recommendations for screening, immunizations, and disease management.

IO5.6 Identify when specialty consultation is indicated based on patient needs, disease severity, or required procedures.

_(B1.03g)

The PAEA Surgery EOR Topic List and Blueprint should be utilized in preparation for the End of Rotation Exam. Both the Topic List and Blueprint can be found on the Principles of Surgery Canvas course page and on the PAEA website.

^(B1.03h)

Student progress will be assessed in a variety of ways, which include the following:

Description of Assessments

• Preceptor Evaluation (50%): At the end of each supervised clinical practice experience, students are formally evaluated by a program-approved preceptor. The evaluation uses a 7-point Likert scale where a score of 4 represents benchmark performance, reflecting the expected level for an average clinical year PA student. Scores above 4 indicate performance exceeding expectations, while scores consistently below 4 reflect performance below program standards and may require remediation. Evaluations must be completed by a designated preceptor, defined by ARC-PA as clinical instructional faculty providing direct supervision.  
• End of Rotation Exam (40%): The PAEA Surgery End of Rotation Exam is a standardized assessment of medical knowledge gained during each core clinical rotation. Each exam consists of approximately 120 multiple-choice questions built around a specific blueprint and topic list aligned with PA practice parameters. Designed to evaluate mastery of content tied to the program’s learning outcomes, these exams serve as one measure of a student’s readiness for clinical practice.  
• Professionalism (10%): Professionalism is evaluated by the timely, and accurate, completion of the following assessments by the due date as indicated on the LMS course page: 
• Patient logging documentation in eValue (40%): Students are required to log all patient encounters daily during all supervised clinical practice experiences (SCPEs) Logs should capture a variety of patients across the lifespan and include preventive, acute, and chronic conditions. In addition, students must log the encounter setting (outpatient and telemedicine). This process ensures students gain broad clinical exposure in the family medicine setting and develop the skills needed to meet program learning outcomes for family medicine. Patient logging must demonstrate a minimum of:
  • 15 Operating Room Encounters
  • 10 Post-Operative Visits
  • 5 Pre-Operative Visits
  • 1 Pre-Operative Time Out Procedure
• Time Tracking Documentation in eValue (20%): Students are required to log their projected clinical hours and final amount of clinical hours completed during the supervised clinical practice experiences (SCPEs). Logs should capture the time in which the student was actively involved in the delivery of patient care, including chart review. Of note, no more than 20% of the clinical hours for this rotation can be conducted via telehealth/telemedicine encounters. This process ensures students gain broad clinical exposure in the surgery setting and develop the skills needed to meet program learning outcomes for surgery.
• Mid-Rotation Self-Assessment (20%): Students are required to complete this assessment as an opportunity to critically reflect on their performance and learning experiences during the first half of the clinical rotation. Through self-evaluation, students will assess their progress toward meeting the course learning outcomes, identify areas of strength and improvement, and develop actionable goals for the remainder of the rotation. This process encourages self-directed learning, professional growth, and meaningful discussions with preceptors regarding performance and development. This assessment form can be found via assignments in the course Canvas page.
• Mid-Rotation Preceptor Evaluation (20%): The Mid-Rotation Preceptor Evaluation is a formative assessment designed to provide students with constructive feedback on their performance during the first half of the clinical rotation. This evaluation offers an opportunity for the preceptor and student to discuss strengths, identify areas for growth, and develop a plan to support continued learning and success during the remainder of the rotation. Preceptors will receive access to this evaluation directly from eValue.

Successful completion of the PHYASST 340 Principles of Surgery course requires completion of all graded components of the course at the required benchmark, in addition to:

• Completion of the preceptor/site evaluation in eValue.
• Completion of the site safety evaluation in eValue.
• Completion of the course evaluation in Canvas.
• Completion of all course attestations in Canvas.
• Achieve a preceptor evaluation of student performance with a score of >70%.
• Achieve a converted score of >70% on the Family Medicine End of Rotation assessment.
• Achieve a passing grade (69.5% or greater) for the course.

Remediation

Failure of the course will require an immediate Independent Study course for remediation, and the student will be required to repeat the Principles of Surgery course. A course failure occurs if the student receives:

• <70% overall course grade;

• <70% score on the final preceptor evaluation of the student’s performance;

• <70% on EOR exam retake.

A Principles of Surgery Study course for remediation will be required if the student receives:

• A Low Pass (70%-77%) score on the final preceptor evaluation of the student’s performance;

• Four (4) or more low pass and/or fail scores for learning outcomes on the final preceptor evaluation of the student’s performance;

  • In some instances, an Independent Study may be required if a student receives fewer than 4 low pass and/or fail scores. This will be dependent upon the nature of the elements requiring remediation, as some areas highlight concern for a global deficit. This determination is made by, and is at the discretion of, the program.

Any single low pass or failed learning outcome on final preceptor evaluation of the student’s performance will require remediation at the course level. Remediation of learning outcomes may consist of written assignments, clinical shifts, clinical simulations, and other didactic learning opportunities. 

Note: For further information regarding academic standing in the Duke Physician Assistant Program, please see the DPAP Student Handbook and the Program Grading Standards.

Students are prohibited from using generative AI tools (including but not limited to ChatGPT, Google Bard, or Dall-E2) on assignments, remediations, or assessments in this course. Students are expected to complete each assignment without substantive assistance from others or automated tools, unless specifically instructed otherwise. Failure to abide by this policy constitutes a violation of the Code of Professional Conduct and may result in adverse academic action per program policies.

Course materials including session objectives, lecture notes, and assignment details are posted as appendices to this syllabus on the course site within the program Learning Management System (Canvas). The School of Medicine Bulletin contains additional institutional and program policies, including the program’s technical standards.

Duke University is committed to providing equal access to students with documented disabilities. Students may contact the Student Disability Access Office (SDAO) to discuss reasonable accommodations for both classroom and clinical settings. Students are encouraged to register with SDAO as soon as they begin the program, as accommodations are not applied retroactively.

Website: https://access.duke.edu/ | Phone: 919-668-1267 | Email: SDAO@duke.edu