Guide Book April 2014

Guidebook
Medical Student
Clerkship Program
SURGERY(C12A 001)
DEPARTMENT OF SURGERY
FACULTY OF MEDICINE - UNIVERSITAS PADJADJARAN
Dr. Hasan Sadikin Hospital - Bandung
2014
1
Guidebook Medical Student Clerkship Program in Surgery, April 2014
INTRODUCTION
Medical 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
2
CONTENTS
Introduction
Chapter I Preface
Program
description
Vision
and
Mission
.
.
General
objectives
...
Specific
objectives
..
.
Clerkship
duration
...
Clerkship
location
...
.
General
rules
...
.
Night
shift
rules
...
.
Sanction
...
.
Exchange
/
Visiting
Medical
Student
Precautions
...
Chapter II Department Faculties
Teaching
staff
..
.
Medical
Student
Affairs
...
Facilities
.
...
Chapter III Materials and Subjects
Basic 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
1
4
4
4
5
5
6
6
6
7
8
8
9
10
10
12
12
13
13
13
14
20
24
3
Chapter IV Routine Activities

Rotation
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
.
Chapter V Evaluation
Mini
Clinical
Examination
..
.
Direct Observational Procedural Skills (DOPS) .
Final
Examination
...
.
Professional
behavior
evaluation
..
Scoring
..
Mark
conversion
..
25
25
25
26
27
28
28
29
30
31
32
33
34
35
36
37
37
38
38
38
39
40
40
40
4
Rules for Remedial or failed student .....

..
Feedback
.
.
References
40
Chapter I Preface
5
Program description
Medical 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 knowledges
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 Mission
In 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 surgery

General 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 knowledges 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 knowledges and always committed to longlife learning and follow on the latest development of science
6
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 science
2. 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 SKDI
4. Explain basic perioperative care
5. Demonstrate appropriate non-operative clinical surgery skills
6. Demonstrate appropriate basic surgery skills
7. Behave professionally in patient treatment based on good
surgical practice, and apply the principles of Bioethics and
Humanism.
Rotation duration and place

The duration of clerkship rotation is 9 weeks. Rotation will be
conducted fully in Hasan Sadikin Hospital (RSHS) in 1 st, 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 Sanctions

General Rules
1.
2.
3.
4.
5.
Prior clerkship, student already complete all the necessary

university (faculty of medicine) administration
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.
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.
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.
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
7
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
room for short briefing with clerkship coordinator (if the

conference room is vacant). The logbook and the guidebook will
be distributed.
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.
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.
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.
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.
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.
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
Each student must behave professionally, discipline, and obey the
regulation.
Student are not allowed to conduct assignment from other
department.
Student are not allowed to wear the white coat outside the
hospital.
Student are not allowed to examine patient while carry a
backpack.
Night shift rules

1.
2.
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 subspecialty, 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.
If the student unable to attend the night shift due to illness or
personal matter, student must reschedule the lost night shift
8
to other day.
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 prohibited
10. 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.
3.
Sanctions
1. 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 Student

Our 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
9
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.
Precautions
Hasan 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 Precaution
In 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 recommended
2. Consistent in performing Universal Precaution (UP)
3. Wear a mask if there is suspected air-borne disease
10
Chapter II Staff
Chair
Head 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 department

Digestive Surgery
Head of division
Maman Wastaman Rodjak, dr., SpB-KBD
Staff
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-KBD
Surgical Oncology
Head of division
Fransisca Badudu, dr., SpB(K)Onk
Staff
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)Onk
Pediatric Surgery
Head 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., SpBA
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Urology
Head of Division
Dr. Bambang Sasongko Nugroho, dr., SpB., Sp.U
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 Surgery
Head 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 Surgery
Head 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 Surgery
Head 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 Neurosurgery
Head of Department
Dr. M. Zaffrullah Arifin, dr., SpBS(K)
Staff
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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
Department of Orthopaedic and Traumatology

Head of Department
Nucki N. Hidajat, dr., SpOT(K)., FICS., M.Kes
Staff
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 affairs

Coordinator
: Teguh Marfen Djajakusumah, dr., Sp.B-(K)V., Mkes
Sub-coordinator: Rizky Diposarosa, dr., SpB., SpBA
Rama Nusjirwan, dr., Sp.BTKV
Secretary
: Dicky Maulana
Facilities
Facilities in Department of Surgery:
1. Conference room R. Koestedjo, commonly used for emergency
report, journal reading, case report, lecture for medical student
2. Internet through Wi-Fi
3. Discussion room in each division
4. Learning facilities: Surgery clinics (9 clinics division and 1 general
surgery clinic), Surgery Wards (Kemuning, Kana, Anthurium,
and Aglonaema), Central Operating Theater (Emergency, Elective
13
and One-Day Surgery) and Emergency Room

5. Sattelite Hospital (Salamun, Cibabat, and Ujung Berung Hospital)
Chapter III Subject and Matter

Expected Competencies
(Based on Standard of Indonesian Medical Doctor Competencies
or Standar Kompetensi Dokter Indonesia - SKDI)
Basic Surgical Knowledges Competencies
1. Able to explain type of minor surgery
2. Able to explain type of major surgery
3. Able to explain informed concent
4. Able to explain universal precaution andinfection prevention
5. 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 Competencies
1. Demonstrate the process of good informed consent
2. Demonstrate the process of universal precaution and infection
prevention
3. Demonstrate the process of applying local anesthetic
4. 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
14
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 explain
Graduated 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
appropriate referral
Level of Competency 2: diagnosis and referral
Graduated 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 referral
3A. Non-emergency case
Graduated 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 case
Graduated 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
treatment
Graduated 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
15
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 Skills
Expected level of clinical skills competencies (SKDI)
According to SKDI, clinical skills competencies are divided to 4 levels,
based on the Millers pyramid (knows, knows how, shows, does);
Level of competencies 1: Knows and able to explain
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 demonstrated
Graduated 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 graduation
4B: 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,
Level
of
16
And clinical skills competencies
competency
Note: yellow color indicate as possible as national OSCE case

Level 1 or 2 could be use for CSS or CRS topics
Vascular surgery:
Arterial disease
1.
Abdominal Aortic Aneurysm (AAA)
2.
Aortic dissection
3.
Peripheral Artery Disease
- Diabetic foot *
- Thromboangiitis obliterans (Buergers disease)
- Raynauds syndrome
- Arterial thrombosis
- Arterial embolism
- Claudication
- Lower extremity ulcer
Venous disease
4.
Varicose vein
5.
Chronic Venous Insufficiency
6.
Deep Vein Thrombosis
7.
Venous embolism
8.
Thrombophlebitis
Lymphatic disease
9.
Lymphangitis
10. Lymphedema
Primary
Secondary (elephantiasis - filariasis)

Vascular anomalies
6.
Infantile Hemangioma
7.
Vascular malformation*
Venous malformation
Capillary malformation
Lymphatic malformation (limfangioma)
Arteriovenous malformation (AVM)

List of Clinical Skills:
Carotid artery palpation
Palpation of peripheral arterial pulses
Capillary refill time
Detection of bruit
Brodie Trendelenburg test
Perthes test
Reactive Hyperemia test for arterial insufficiency
1
1
2
2
2
1
2
4A
2
3A
2
2
3A
3A
3A
2
-
4A
4A
4A
4A
4A
3
3
17
Postural test for arterial insufficiency

Homans test
Ankle-brachial index
Doppler ultrasound
Venous puncture
Arterial puncture
Finger prick
Venous cutdown
Pediatric venous cutdown
Cardiothoracic surgery:
Thoracic disease
1.
Lung cancer
2.
Pleural Effusion
3.
Massive pleural effusion
4.
Pneumothorax
5.
Tension pneumothorax
6.
Atelectasis
7.
Lung abscess
8.
Hematothorax
9.
Mediastinal tumor
10. Rib fracture (includingflail chest) *
11. Lung contussion *
12. Thoracic Empyema *
13. Open thoracic surgery on TB *
Cardiac disease
9.
Acquired* (CABG surgery, Valve surgery)
Congenital* (Cyanotic: Tetralogy of Fallot,
Non-cyanotic: ASD, VSD, PDA)
Respiratory inspection
Chest inspection
Chest auscultation
Chest percussion
Chest palpation
Pleural tap
Superficial FNAB
Trans thoracal needle aspiration
Needle decompression
Chest tube insertion
Water Sealed Drainage (WSD) care
Pleural puncture
3
3
3
2
4A
3
4A
3
3
2
2
3B
3A
3A
2
3A
3B
2
-
4A
4A
4A
4A
4A
3
2
2
4A
3
4A
3
18
Oxygen therapy
Digestive surgery:
Abdominal wall
1.
Reponible and ireponible hernia (inguinal,
femoral, scrotal)
2.
Incarcerated or strangulated hernia
3.
Umbilical hernia
Acute abdomen
4.
Acute appendicitis
5.
Appendicular abscess
6.
Peritonitis, due to:
Perforated appendix, typhoid, gastric
Other source of perforation

7.
Gastrointestinal bleeding
8.
Chole(docho)lithiasis
9.
Acute Cholecystitis
10. Pancreatitis
11. Ileus (bowel obstruction)
12. Obstructive jaundice *
Colorectal
13. Diverticulosis, diverticulitis
14. Colitis
15. Colorectal cancer
16. Rectal, anal prolapsed
17. Hemorrhoids grade 1-2
18. Hemorrhoids grade 3-4
19. (peri)anal abscess
20. Perianal fistula
21. Anal fissure
Others
22. Amebic liver abscess
23. Tetanus
24. Snake or animal bites *
25. Hipovolemic shock (bleeding)
26. Trauma abdomen *
Abdominal inspection and palpation
Groin inspection and palpation
Hernia palpation
Psoas sign and obturators sign
Digital rectal examination
4A
2
3B
3B
3A
3B
3B
3B
2
3B
2
2
3A
3A
2
3A
4A
3A
3A
2
2
3A
3B
3B
4A
4A
4A
4A
4A
19
Nasogastric tube insertion

Endoscopy
Nasogastric tube suction
Colostomy bag replacement
Enema
Anal swab
Gastroscopy
Proctoscopy
Ascites sampling
Abdominal ultrasound
Pediatric surgery
1.
Intussuception / Invagination
2.
Anal Atresia (anorectal malformation)
3.
Fistula umbilical, omphalocele,gastroschizis
4.
Billiary Atresia
5.
Intestinal Atresia
6.
Esophageal Atresia
7.
Hirschsprungs disease
8.
Hydrocele
9.
Reponible and ireponible hernia (inguinal,
femoral, scrotal)
10. Incarcerated or strangulated hernia
11. Umbilical Hernia
12. Undescended testis
13. Phymosis
14. Paraphymosis
15. Cystic hygroma
16. Hypospadia
History taking from third party, or older children, or
anxious parents
General pediatric physical examination
Congenital malformation observation
Pediatric peripheral IV cannulation
Pediatric intubation
Oropharynx tube insertion
Intraosseus cannulation
Circumcision
Airway, breathing management
Emergency rehidration
4A
2
4A
4A
4A
4A
2
2
3
2
3B
2
2
2
2
2
2
2
2
3B
2
2
4A
4A
2
2
4A
4A
4A
4A
3
2
2
4A
3
4A
20
Plastic surgery
1.
Cleft lip and Palate
2.
Angina ludwig
3.
Lacerated wound
4.
Perforated, penetrated wound
5.
Maxillofacial trauma *
6.
Peritonsillar abscess
7.
Hidradenitis supurativa, carbuncle
8.
Ingrowing toenails
9.
Ganglion cyst
10. Lipoma
11. Burn, 1st and 2nd degree
12. Burn, 3rd degree
13. Burn, chemical
14. Burn, electrical
Infiltration anesthesia
Local nerve block
Topical anesthesia
Wound suturing
Suture removal
Analgesic administration
Incision and drainage of abscee
Excision of benign skin tumor
Wound care
Rozerplasy
Bandaging
Urology
1.
Benign Prostatic Hyperplasia
2.
Urethral rupture
3.
Bladder rupture
4.
Kidney rupture
5.
Torsion of Testis
6.
Urethral stricture
7.
Varicocele
8.
Hydrocele
9.
Urinary stone disease or urinary calculi
10. Priapism
11. Renal colic
12. Asymptomatic urinary tract stone disease
13. Urinary tract infection
2
3A
4A
3B
3A
4
4
4
4A
4A
3B
3B
3B
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
2
3B
3B
3B
3B
3A
2
2
3A
3B
3A
3A
4A
21

Bimanual kidney examination
Costovertebral angle tenderness examination
Bladder palpation
Prostate palpation
Bulbocavernous reflex
Uroflowmetry
Plain abdomen and IVP x-ray interpretation
Urethral catheterization
Clean intermitten catheterization
Suprapubic puncture
Circumcision
Penis, scrotum inspection and palpation
Scrotum transilumination test
Surgical Oncology
Breast disease
1.
Breast cancer
2.
Phyllodes tumor
3.
Fibroadenoma of the breast
4.
Mastitis
5.
Breast abscess
6.
Pagets disease of the breast
7.
Cracked nipple
8.
Inverted nipple
Thyroid disease
9.
Goitre
10. Thyroid adenoma
11. Thyroid cancer
Skin disease
12. Nevus pigmentosus
13. Malignant melanoma
14. Squamous cell carcinoma
15. Basal cell carcinoma
Others
16. Non-Hodgkins lymphoma
17. Hodgkins lymphoma
18. Other soft tissue tumors: fibrosarcoma,
rhabdomyosarcoma, leimyosarcoma
19. Branchial cyst and fistula
20. Tumor lidah *
21. Tumor rongga / dasar mulut *
4A
4A
4A
4A
3
1
3
4A
3
3
4A
4A
4A
2
1
2
4A
2
1
4A
4A
3A
2
2
2
1
2
2
1
1
1
2
22
22. Lymphadenopathy
23. Lymphadenitis
General and Breast Examination
Self-Breast examination education
Thyroid palpation
Axillary lymphatic node palpation
Salivary gland palpation
Lymph node examination
Orthopaedic surgery
Trauma
1.
Open fracture, close fracture
2.
Clavicle fracture
3.
Pathologic fracture
4.
Fracture and disclocation of vertebrae
5.
Extremity disclocation
6.
Join trauma
7.
Achilles rupture
Degenerative
8.
Osteoarthritis
9.
Osteoporosis
10. Spondilitis
Others
11. Primary and secondary bone tumor
12. Osteomyelitis
13. Congenital malformation
14. Carpal tunnel syndrome
15. Tarsal tunnel syndrome
Gait inspection
Supine-backbone inspection
Moving-backbone inspection
Extremity muscle tone inspection
Extremity join inspection
Inspection of backbone and pelvic postural
Inspection of scapular position
Inspection of spine flexion and extension
Assesment of lumbal flexion
Assesment of flexion, extension, adduction, abduction
and rotation of Hip
Assesment of muscle atrophy
3A
4A
4A
4A
4A
4A
4A
4A
3B
3A
2
2
2
3A
3A
3A
3A
2
2
3B
2
3A
3A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
23
Knee: Assesment of cruciate and lateral ligament

Meniscus evaluation
Postural and shape inspection of foot
Dorsal and plantar flexion, inversion, eversion of foot
Palpation for tenderness
Palpation for detection of vertical pressure pain
Palpation of tendon and join
Back bone and muscle, sacro-iliac join palpation
Percussion for tenderness
Evaluation of join ROM (Range Of Motion)
Evaluation of Head ROM
Shoulder join and muscle function test
Wrist, metacarpal, finger join function test
Leg discrapency examination
Close fracture reposition
Fracture stabilisation (without casting)
Reduction of dislocation
Application of Dressing (Sling, bandage)
Join aspiration
Splinter removal
Neurosurgery
Trauma
1.
Epidural hematoma
2.
Subdural Hematoma
3.
Spinal cord injury
4.
Complete spinal transection
Others
5.
Hydrocephalus
6.
Hernia of Nucleus Pulposus (HNP)
7.
Spondylitis TB
Glasgow Coma Scale examination
Vertebral inspection, percussion, and palpation
Skull x-ray interpretation
Vertebral x-ray interpretation
Head CT-Scan and interpretation
List of general Clinical Skills:
Skin test
Blood test examination
Plain x-ray interpretation
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
4A
3
4A
3
4A
2
3
2
2
2
3B
2
3A
3A
4A
4A
4A
4A
2
4A
4A
4A
24
Contrast x-ray interpretation

Minor surgery prep: a and antiseptic, local anesthesia
Observer or assistant in major surgery: Scrubbing,
Gowning, Gloving
Patient transport
Basic life support
Mask ventilation
Intubation
Fluid resuscitation
3
4A
4A
4A
4A
4A
3
4A
Clinical Skills in pre-clerkship phase

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 SKDIs clinical skills, but considered as important skills for
medical student.
List of clinical skills:
1. Airway and ventilatory management
2. Breathing; ventilation and oxygenation
3. Circulation with hemorrhage control
4. Oropharingeal and nasopharingeal airway insertion
5. Respiratory history taking and physical examination in adult
6. Oxygen therapy in adult and pediatric
7. Needle thoracostomy
8. Breast and axilla examination
9. 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 abdomen
12. Nasogastric tube insertion
13. IV catheter insertion
14. History taking and physical examination of jaundice patient
15. History taking and physical examination of groin lump
16. Digital Rectal Examination
17. Urinary catheterization
18. Suprapubic puncture
25
19.
20.
21.
22.
23.
24.
Circumcision
History taking and physical examination in orthopaedic
Wood splinting and bandaging
Skin traction
Wound toilet and debridement of open fracture
Basic Surgical Skills
BSS instrument and knotting
Local anesthesia
Suturing
Minor surgery
Chapter IV - Routine activities

Clerkship Duration:
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.
26
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
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 supervision
The 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 students final
examination (OSCE) as a bystander.
Resident have a medical students 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 activities
Department 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
27
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 preceptors contact
number.
Place of activities
Learning activities will be conducted in each division / department;
student must adhere to each division / department schedule (except for
general activities such as emergency report).
28
Weekly schedule for each Division / Department

Division of Digestive Surgery
Day
Mo
Tue
Wed
Thu
Time
06-07
07-08
08-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
Activities
Resident round
Emergency report
Daily activities
Break
BST
Night shift
Resident round
Resident presentation
Patients parade
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Resident case report
Daily activities
Break
CRS
Night shift
Resident round
Grand round
Place
Ward
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
Digestive room
Digestive room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Digestive room
Clinic or OR
Preceptor
ER
Ward
Kemuning L. 4
29
Fri
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-11
11-13
13-15
15-09
General Lecture
Daily activities
Break
Mini-Cex
Night shift
Resident round
Emergency report
Daily activities
Break, Friday pray
Daily activities
Night shift
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Clinic or OR
ER
Division of Oncology Surgery

Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-09
09-10
10-12
12-13
13-15
15-06
06-07
07-08
08-12
12-13
13-15
15-06
06-07
07-08
08-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
Activities
Resident round
Emergency report
Patients parade
Grand round
Daily activities
Break
BST
Night shift
Resident round
Referat Residen
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Daily activities
Break
CRS
Night shift
Resident round
Residen presentation
General Lecture
Daily activities
Break
Place
Ward
Koestedjo room
Onkology room
Kemuning L. 3
Clinic or OR
Preceptor
ER
Ward
Konfrens Onkologi
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
Onkology room
Koestedjo room
Clinic or OR
30
Fri
13-15
15-06
06-07
07-08
08-11
11-13
13-15
15-09
Mini-Cex
Night shift
Resident round
Emergency report
Daily activities
Break, Friday pray
Daily activities
Night shift
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Clinic or OR
ER
Division of Pediatric Surgery

Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
Activities
Resident round
Emergency report
Daily activities
Break
BST
Night shift
Resident round
Pediatric EMG Report
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Daily activities
Break
CRS
Night shift
Resident round
PatientsParade
General Lecture
Daily activities
Break
Mini-Cex
Place
Ward
Koestedjo room
Pediatric Surgery room
Clinic or OR
Preceptor
ER
Ward
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Preceptor
31
Fri
15-06
06-07
07-08
08-09
09-11
11-13
13-15
15-09
Night shift
Resident round
Emergency report
Grand round
Daily activities
Break, Friday pray
Daily activities
Night shift
ER
Ward
Koestedjo room
Kemuning L. 2
Clinic or OR
Clinic or OR
ER
Division of Plastic Surgery

Day
Mon
Tue
Wed
Thu
Fri
Time
06-07
07-08
08-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
Activities
Resident round
Emergency report
Daily activities
Break
BST
Night shift
Resident round
Plastic EMG report
Case report
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Daily activities
Break
CRS
Night shift
Resident round
Referat Residen
General Lecture
Daily activities
Break
Mini-Cex
Night shift
Resident round
Place
Ward
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
Plastic surgery room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Preceptor
ER
Ward
32
07-08
08-09
09-11
11-13
13-15
15-09
Emergency report
Patients parade
Grand round
Break, Friday pray
Daily activities
Night shift
Koestedjo room
Kemuning L. 4
Clinic or OR
ER
Division of Urology
Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
Activities
Resident round
Emergency report
Patients parade
Daily activities
Break
BST
Night shift
Resident round
Urology EMG report
Patients parade
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Patients parade
Daily activities
Break
CRS
Night shift
Resident round
Grand round
General Lecture
Daily activities
Break
Mini-Cex
Place
Ward
Koestedjo room
Urology room
Clinic or OR
Preceptor
ER
Ward
Urology room
Urology room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Urology room
Clinic or OR
Preceptor
ER
Ward
Kemuning L. 4
Koestedjo room
Clinic or OR
Preceptor
33
Fri
15-06
06-07
07-08
08-11
11-13
13-15
15-09
Night shift
Resident round
Emergency report
Daily activities
Break, Friday pray
Daily activities
Night shift
ER
Ward
Koestedjo room
Clinic or OR
Clinic or OR
ER
Division of Vascular Surgery

Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-10
10-12
12-13
13-15
15-06
06-07
07-10
10-12
12-13
13-15
15-06
06-07
07-08
08-10
10-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
Activities
Resident round
Emergency report
Science session
Daily activities
Break
BST
Night shift
Resident round
Science session
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Science session
Daily activities
Break
CRS
Night shift
Resident round
Science session
General Lecture
Daily activities
Break
Mini-Cex
Night shift
Place
Ward
Koestedjo room
Vascular surgery room
Clinic or OR
ER
Ward
Clinic or OR
ER
Ward
Koestedjo room
Clinic or OR
ER
Ward
Koestedjo room
Clinic or OR
ER
34
Fri
06-07
07-08
08-10
10-11
11-13
13-15
15-09
Resident round
Emergency report
Science session
Daily activities
Break, Friday pray
Science session
Night shift
Ward
Koestedjo room
Clinic or OR
ER
Division of Orthopaedic Surgery

Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-10
10-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
Activities
Resident round
Emergency report
Daily activities
Break
BST
Night shift
Resident round
Orthopaedic EMG report
Grand round
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Science session
Daily activities
Break
CRS
Night shift
Resident round
Orthopaedic EMG report
General Lecture
Daily activities
Break
Mini-Cex
Place
Ward
Koestedjo room
Orthopaedic room
Clinic or OR
Preceptor
ER
Ward
Orthopaedic room
Anthurium/Aglonaema
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Orthopaedic room
Clinic or OR
Preceptor
ER
Ward
Orthopaedic room
Koestedjo room
Clinic or OR
Preceptor
35
Fri
15-06
06-07
07-08
08-11
11-13
13-15
15-09
Night shift
Resident round
Emergency report
Daily activities
Break, Friday pray
Daily activities
Night shift
ER
Ward
Koestedjo room
Clinic or OR
Clinic or OR
ER
Division of Neurosurgery
Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-10
10-12
12-13
13-15
15-06
06-07
07-10
10-12
12-13
13-15
15-06
06-07
07-08
08-10
10-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
Activities
Resident round
Emergency report
Science session
Daily activities
Break
BST
Night shift
Resident round
Science session
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Science session
Daily activities
Break
CRS
Night shift
Resident round
Science session
General Lecture
Daily activities
Break
Mini-Cex
Place
Ward
Koestedjo room
Neurosurgery room
Clinic or OR
Preceptor
ER
Ward
Neurosurgery room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Neurosurgery room
Clinic or OR
Preceptor
ER
Ward
Neurosurgery room
Koestedjo room
Clinic or OR
Preceptor
36
Fri
15-06
06-07
07-08
08-09
09-11
11-13
13-15
15-09
Night shift
Resident round
Emergency report
Grand round
Daily activities
Break, Friday pray
Daily activities
Night shift
ER
Ward
Koestedjo room
NCCU
Clinic or OR
Clinic or OR
ER
Division of Cardiothoracic Surgery

Day
Mon
Tue
Wed
Thu
Time
06-07
07-08
08-09
09-10
10-12
12-13
13-15
15-06
06-07
07-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
13-15
15-06
06-07
07-08
08-09
09-12
12-13
Activities
Resident round
Emergency report
Patients Parade
Grand round
Daily activities
Break
BST
Night shift
Resident round
Daily activities
Break
CSS
Night shift
Resident round
Emergency report
Grand round
Daily activities
Break
CRS
Night shift
Resident round
General Lecture
Daily activities
Break
Place
Ward
Koestedjo room
Cardiothoracic room
Ward
Clinic or OR
Preceptor
ER
Ward
Cardiothoracic room
Clinic or OR
Preceptor
ER
Ward
Koestedjo room
Ward
Clinic or OR
Preceptor
ER
Ward
Cardiothoracic room
Koestedjo room
Clinic or OR
37
Fri
13-15
15-06
06-07
07-08
08-11
11-13
13-15
15-09
Mini-Cex
Night shift
Resident round
Emergency report
Daily activities
Break, Friday pray
Daily activities
Night shift
Preceptor
ER
Ward
Koestedjo room
Clinic or OR
Clinic or OR
ER
Chapter V Evaluation
Students 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 Examination
Mini Clinical Examination (Mini-Cex) evaluation will be conducted by
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 case
2. 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 student
4. 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 taking
b. Physical examination
c. Humanism and professionalism
d. Decision in clinical diagnosis
e. Skills and education
38
f. Efficiency and Organization

g. General clinical competency
6. Preceptor may give an assignment after the examination
Direct Observation of Procedural Skills DOPS
DOPS is an evaluation technique by observing directly students
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
Planning disease management
Counseling or communication of the treatment result
Final examination
During 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 rotation
OSCE 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 minutes
3. OSCE case is daily case and based on SKDI
39
During OSCE, bystander resident will assist and help the examiners.
Evaluation of Professional Behavior
This 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, Compassion
2. Respect, Cultural Competence
3. Honesty, Honor, Integrity
4. Excellence & scholarship
5. Dutifulness & Responsibility
6. Communication
Evaluation and Scoring

Activities
1. Scores by preceptor
- BST
- CRS
- CSS
- Mini-Cex or DOPS
- Others
Weighted(%)
50%
2. Final Examination
Logbook
50%
*
Professional behavior
Total
30
25
25
10
10
Explanation
Cumulative of 9
preceptors
Behavior,
attitude,
ethics,
discipline
(absent), night shift
OSCE
*Logbook (filled) is a
requirement for judicium
*Observed
Behaviors.
Some
unaccepted
behavior will affect the
judicium
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
40
0.7 + PS x 0.2 + UA x 0.1

Scores conversion
Value
80 100
A
76 79
B++
72 75
B+
68 71
B
< 68
C
Student will be considered PASS if the score is 68 or above (B)
Score
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
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
Feedback
In 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 dont
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. Schwartzs Principles of surgery, 9th Ed., McGraw-Hills, 2010.
41
2. Standard Kompetensi Dokter Indonesia KKI, 2012

Teguh Marfen Djajakusumah 2013
42

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Guidebook

Chapter IV Routine Activities

Rules for Remedial or failed student .....

Goals of medical education in the field of surgery

especially in the fields of surgery.

Specific goals (Specific competencies to be achieved)

Rotation duration and place

Rules and Sanctions

Prior clerkship, student already complete all the necessary

Guidebook Medical Student Clerkship Program in Surgery, April 2014

room for short briefing with clerkship coordinator (if the

Night shift rules

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

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Exchange / Visiting Medical Student

Staff and its division and department

Ahmad Imron, dr., SpBS

Department of Orthopaedic and Traumatology

Medical student affairs

and One-Day Surgery) and Emergency Room

Chapter III Subject and Matter

Competencies based on Scope of Subject

surgery). Student would be distributed to 9 division, and the listed

Scope based on competencies (SKDI) and

Guidebook Medical Student Clerkship Program in Surgery, April 2014

And clinical skills competencies

Note: yellow color indicate as possible as national OSCE case

Secondary (elephantiasis - filariasis)

Lymphatic malformation (limfangioma)

Arteriovenous malformation (AVM)

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Postural test for arterial insufficiency

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Perforated appendix, typhoid, gastric

Other source of perforation

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Nasogastric tube insertion

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

List of Clinical Skills:

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Knee: Assesment of cruciate and lateral ligament

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Contrast x-ray interpretation

Clinical Skills in pre-clerkship phase

Chapter IV - Routine activities

Emergency morning report: student must attend the morning

Supervision and teaching by resident:

Weekly schedule for each Division / Department

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Oncology Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Pediatric Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Plastic Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Vascular Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Orthopaedic Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Cardiothoracic Surgery