Internship at the Medical University of South CarolinaAllison BossongHLTH 4200Summer 2016

Introduction• For the summer of 2016 I was given the opportunity to intern at the

Medical University of South Carolina (MUSC) Department of Gastrointestinal (GI) Surgery in Charleston, SC.

• This presentation depicts an overview of the internship, including information on the following topics:• MUSC Site Description• MUSC Mission and Goals• Department Description• Internship Preceptor• Internship Attending Surgeons• Roles and Duties

• Clinical Shadowing• Projects

• The Operating Room• SCAPA Monthly Meeting• Conclusions

MUSC Site Description• The Medical University of South Carolina (MUSC) is South

Carolina's only comprehensive academic medical center. MUSC Health is changing what's possible in health care through their ongoing mission to provide excellence in patient care, teaching, and research

• MUSC has served the citizens of South Carolina since 1824. • It originated as a small private college for the training of

physicians to a state university with a medical center and six colleges for the education of a broad range of health professionals.

• The clinical enterprise now is comprised of a 700-bed medical center. It serves patients through four hospital facilities in Charleston and more than 100 outreach sites.

MUSC Site Description• The Gastrointestinal Surgery Department is a part of the

Digestive Disease Center at MUSC Ashley River Tower.• The GI Surgery Department is spread out across different floors

of Ashley River Tower:• The GI Surgery clinic is located on the first floor.• The GI operating rooms are located on the fourth floor.• The post operative recovery hospital rooms are located on the sixth

floor.

This is a photo of me outside of Ashley River Tower.

MUSC Vision, Mission, and Values• The Vision• To be nationally recognized as a Premier Academic Medical

Center (MUSC Health).• To be a leading and transformative Academic Health Center

(University).• The Mission• Improve health and maximize quality of life through education,

research, and patient care.• The Values• Integrity, Trust, Respect, Social Responsibility, Fiscal

Responsibility, Cultural Competence, Adaptability, and Sustainability.

Department Description: GI Surgery Clinic

These are the doors of the GI surgery clinic that patients pass through to get to the exam rooms.

• The GI surgery clinic sees pre-operation and post-operation patients on a daily basis. • The pre-operation patients are

evaluated for whether or not they are candidates for surgery.

• The post-operation patients are evaluated for how well they are recovering from surgery. The providers look for signs of complications and prescribe medication to aid in recovery.

• The clinic commonly treats patients with pancreatitis, cholecystitis, GERD, hernias, cancer, and other GI related diseases.

Department Description: GI Surgery Clinic

Pictured above is one of the GI surgery clinic patient exam rooms.

This is a photo of the GI surgery clinic office where I worked alongside the providers.

Internship Preceptor• Stefanie Owczarski is Physician

Assistant (PA) for the Department of Surgery GI Clinic.

• She also serves as the clinical research manager for the Division of Gastrointestinal and Laparoscopic Surgery.

• She is also a Clinic Instructor for the MUSC Physician Assistant PA program. She serves as a preceptor for PA students on their surgical rotation. Stefanie also guest lectures on the pancreas for the MUSC PA students once a year.

Pictured with me above is my internship preceptor Stefanie Owczarski, PA-C, MPAS.

Internship Attending Surgeons• Stefanie Owczarski works alongside world-renowned physicians in the GI

Surgery clinic. These physicians specialize in pancreatobiliary surgery and laparoscopic surgery.

• I was fortunate to also be able to shadow and get to know these attending surgeons below.

Dr. Katie MorganProfessor of SurgeryChief, Division of GI & Laparoscopic Surgery

Dr. Rana PullattAssociate ProfessorDirector of MUSC Robotic Surgery

Dr. David AdamsProfessor of SurgeryInterim Chairman of the Department of Surgery

Roles and Duties• My main role includes observing the daily running

of a surgery clinic and shadowing the providers in the clinic. I learned to differentiate between provider team roles at the clinic.• I learned medical terminology by reading patient

notes in the medical chart database, Epic. • Another responsibility of my internship was to

obtain some direct patient contact experience in the clinic. • I helped by adjusting patient gastric pacers,

providing wound care, removing patient staples, uploading patient CT scans, and explaining the surgical scrub.

• My main project was the clinical research project that I worked on with Stefanie. • The project was working with the Islet Cell

Longitudinal Outcome Database to collect data on patients who are status-post total pancreatectomy with islet autotransplant.

This is a photo of me explaining how to use the surgical scrub the morning of surgery.

Clinical Shadowing• I shadowed Stefanie on Tuesdays, Wednesdays, and Fridays in the

clinic.• Tuesdays we worked with Dr. David Adams.• Wednesdays we worked with Dr. Katie Morgan.• Fridays were Stefanie’s individual clinic day where she saw mainly gastric

neurostimulator device patients.

This is a photo of the gastric neurostimulator device that is surgically implanted into patients with gastroparesis.

This is a photo of the Medtronic clinician programmer. It measures and adjust for pacer impedance, cycle time, voltage, rate, and battery.

Clinical Shadowing

This is a photo of my badge that I was required to wear while shadowing in the clinic.

This is a photo of me checking a patient’s gastric neurostimulator device with the the Medtronic clinician programmer.

Projects: Patient Note Questions

• Through shadowing the providers in the clinic, I was able to understand the documentation that goes along with treating patients. I also grasped the proper way to take a complete patient history and physical evaluation.

• In my free time, I researched common questions asked when conducting a patient history and physical.

• Additionally, I have been able to write my own notes about patients. I experienced going into a patient room to ask patient history questions and assess how they had been doing.

• I created a document of proper questions to ask in order to collect the information needed for the GI surgery providers. This is my list I created on patient

note questions.

Projects: Training Certifications• I have completed the MUSC “New Hire” mandatory training modules. These modules

are for any new employee of the MUSC hospital. They were extensive modules that reviewed basic hospital protocol, safety, HIPPA, and other important information.

• I completed the training modules to become Epic trained and certified. This was extremely beneficial because it granted me access to the medical records system at MUSC. The modules walked me through how to properly operate Epic. Epic is a very common medical records data base system and I think this experience in Epic will greatly benefit me in physician assistant school and in my career.

• The CITI Program for Human Subjects Research modules had to be completed prior to beginning my internship. My CITI certificate was submitted to Institutional Review Board for approval so that I could be included on the research team.

Pictured above are my CITI Program for Human Subjects Research, and Epic New Resident certifications.

Projects: My Research Project

• Thursdays were our day specifically set aside for research and we did not see patients in the clinic.

• The project I worked on was the Islet Longitudinal Outcome Database to collect data on patients who are status-post total pancreatectomy with islet autotransplant.

This is a photo of Stefanie’s office where we worked on the research.

Projects: My Research Project• RedCap is a software that supports data capture and research.

The Redcap database is where our research project is located. Stefanie actually created the database so it is very user friendly.

• For the research project, I used the Epic medical record database to read patient charts. The continual use of the database has made me proficient on the database and enabled me to locate patient information quickly.

Projects: My Research Project

• The purpose of this research project is to track patients over the years that are status-post total pancreatectomy with islet autotransplant.

• The data from this research project has been used by many providers in the department for articles, abstracts, and presentations.

Projects: My Research Project• The Islet Longitudinal Outcome Database• I read through patient medical records for specific patient

information regarding medications, lab work, hypoglycemic awareness, pancreatic survey response, and weight/BMI.

These are screenshots of the RedCap template used for data entry.

Projects: My Research Project• The Islet Longitudinal Outcome

Database• I was able to update the database for

patients that had anniversary visits from their date of surgery.

• The database tracks 6 month appointments, 1 year appointments, 2 year appointments, and so on for each individual.

• I mainly input anniversary data ranging from the 6 month to 7 year categories.

• This included updating approximately 175 patients in the database with their medical information and labs from the past 7 years.

The Operating Room

• I had the opportunity to observe a surgical operation performed by Dr. Morgan and the chief resident Dr. Lancaster on June 20th, 2016.

• The surgeons were performing two surgeries one morning and I was invited to scrub in to observe.

• I was very excited about this opportunity because I got to watch the total pancreatectomy and splenectomy with auto islet cell transplantation surgery.

This is a map of the fourth floor displaying the area of the surgical operating rooms.

The Operating Room• The specific surgery that I watched

was the procedure I conducted longitudinal outcomes research on and learned about in the clinic.

• This procedure was not done laproscopically but was an open procedure.

• They surgeons let me stand at the shoulder of the patient, which gave me a great view of everything the surgeons were doing.

• After the first procedure, I watched them do a pancreatic tumor resection, which was also done open instead of laproscopically.

This is a picture of the surgery waiting room. Behind the double doors are where the operating rooms are located.

SCAPA Monthly Meeting• The South Carolina Association (SCAPA) of Physician Assistants

is a professional organization and functions as a volunteer association consisting of an Executive Director, Board of Directors, and various committees.

• Together with other members of the health care team they are working to eliminate barriers to care and enhance existing health care delivery systems.

• The Low Country Area Meeting of SCAPA is held once a month at different restaurants downtown Charleston.

SCAPA Monthly Meeting• Stefanie invited me to attend the June

Low Country SCAPA monthly meeting with her and two other physician assistants in the surgical GI department.

• The meeting was held at Cypress restaurant downtown Charleston.

• The meeting consisted of physician assistants in the area with a presentation from Dr. Jennifer Beaty. She is a local breast surgeon that gave a talk about Breast Cancer.

• The presentation was very informative and it was such a great experience for me to network with other local physician assistants.

This is Cypress restaurant off East Bay Street in downtown Charleston.

Conclusions• I witnessed the daily tasks of the physician

assistant profession for eight weeks. I now feel I have a comprehensive understanding of the role and can speak confidently about the profession. • Additionally, I gained hands on experience in

treating patients in the clinic. • The MUSC hospital allowed me to be fully

immersed into the workings of a medical hospital and specifically an academic teaching hospital. • I learned about different provider roles, as well as

the specialty of GI surgery. • My research project allowed me to get

experience in clinical research and provided training on the medical record database, Epic.

• The MUSC surgical GI department was an incredible internship site and I am very fortunate for the opportunity to have completed my internship there.

This is a photo of me in front of the side of MUSC Ashley River Tower.

References• http://academicdepartments.musc.edu/leadership/

history.html• http://academicdepartments.musc.edu/muscdiversity/

vision.html• http://academicdepartments.musc.edu/surgery/divisions/gi/• http://mcintranet.musc.edu/communications/resources/

facts.htm