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
Guidebook Medical Student Clerkship Program in Surgery, April 2014

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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

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CONTENTS
Introduction 1
Chapter I Preface 4
Program description 4
Vision and Mission .. 4
General objectives ... 5
Specific objectives ... 5
Clerkship duration ... 6
Clerkship location .... 6
General rules .... 6
Night shift rules .... 7
Sanction .... 8
Exchange / Visiting Medical Student 8
Precautions ... 9
Chapter II Department Faculties 10
Teaching staff ... 10
Medical Student Affairs ... 12
Facilities .... 12
Chapter III Materials and Subjects 13
Basic competencies in general surgical knowledge .. 13
Psychomotor competencies .. 13
List of competencies based on surgical division 14
List of competencies based on clinical skills .. 20
List of clinical skills given in undergraduate program 24
Chapter IV Routine Activities 25
Rotation duration . 25
Teaching and Learning method ...................... 25
Weekly activities .. 26
Activity location .... 27
Weekly Schedule for each Division .....
28
Digestive surgery .. 28
Oncologic surgery ..... 29
Pediatric surgery ... 30
Plastic surgery .. 31
Urology ... 32
Vascular surgery .. 33
Orthopaedic .. 34
Neurosurgery .... 35
Cardiothoracic surgery . 36
Chapter V Evaluation 37
Mini Clinical Examination ... 37
Direct Observational Procedural Skills (DOPS) . 38

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Final Examination .... 38
Professional behavior evaluation .. 38
Scoring .. 39
Mark conversion .. 40
Rules for Remedial or failed student ....... 40
Feedback .. 40
References 40

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Chapter I Preface
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 long-life learning and
follow on the latest development of science especially in the fields of
surgery.

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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 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 Sanctions

General Rules
1. 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 room

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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 rules

1. 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 to
other day.

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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 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.
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

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have a recommendation letter from the home university and the faculty
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

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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
Urology

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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
Ahmad Imron, dr., SpBS
Ahmad Adam, dr., SpBS

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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
and One-Day Surgery) and Emergency Room
5. Sattelite Hospital (Salamun, Cibabat, and Ujung Berung Hospital)

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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
Competencies based on Scope of Subject

Expected level of competencies (according to SKDI)

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

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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, b
ased 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 Level

local content (*) according to division, of

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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) 1
2. Aortic dissection 1
3. Peripheral Artery Disease
- Diabetic foot * -
- Thromboangiitis obliterans (Buergers disease) 2
- Raynauds syndrome 2
- Arterial thrombosis 2
- Arterial embolism 1
- Claudication 2
- Lower extremity ulcer 4A
Venous disease
4. Varicose vein 2
5. Chronic Venous Insufficiency 3A
6. Deep Vein Thrombosis 2
7. Venous embolism 2
8. Thrombophlebitis 3A
Lymphatic disease
9. Lymphangitis 3A
10. Lymphedema 3A
Primary
Secondary (elephantiasis - filariasis)
Vascular anomalies
6. Infantile Hemangioma 2
7. Vascular malformation* -
Venous malformation
Capillary malformation
Lymphatic malformation (limfangioma)
Arteriovenous malformation (AVM)
List of Clinical Skills:
Carotid artery palpation 4A
Palpation of peripheral arterial pulses 4A
Capillary refill time 4A
Detection of bruit 4A
Brodie Trendelenburg test 4A
Perthes test 3
Reactive Hyperemia test for arterial insufficiency 3

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Postural test for arterial insufficiency 3
Homans test 3
Ankle-brachial index 3
Doppler ultrasound 2
Venous puncture 4A
Arterial puncture 3
Finger prick 4A
Venous cutdown 3
Pediatric venous cutdown 3
Cardiothoracic surgery:
Thoracic disease
1. Lung cancer 2
2. Pleural Effusion 2
3. Massive pleural effusion 3B
4. Pneumothorax 3A
5. Tension pneumothorax 3A
6. Atelectasis 2
7. Lung abscess 3A
8. Hematothorax 3B
9. Mediastinal tumor 2
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 4A
Chest inspection 4A
Chest auscultation 4A
Chest percussion 4A
Chest palpation 4A
Pleural tap 3
Superficial FNAB 2
Trans thoracal needle aspiration 2
Needle decompression 4A
Chest tube insertion 3
Water Sealed Drainage (WSD) care 4A
Pleural puncture 3

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Oxygen therapy 4A
Digestive surgery:
Abdominal wall
1. Reponible and ireponible hernia (inguinal, 2
femoral, scrotal)
2. Incarcerated or strangulated hernia 3B
3. Umbilical hernia 3B
Acute abdomen
4. Acute appendicitis 3A
5. Appendicular abscess 3B
6. Peritonitis, due to: 3B
Perforated appendix, typhoid, gastric
Other source of perforation
7. Gastrointestinal bleeding 3B
8. Chole(docho)lithiasis 2
9. Acute Cholecystitis 3B
10. Pancreatitis 2
11. Ileus (bowel obstruction) 2
12. Obstructive jaundice * -
Colorectal
13. Diverticulosis, diverticulitis 3A
14. Colitis 3A
15. Colorectal cancer 2
16. Rectal, anal prolapsed 3A
17. Hemorrhoids grade 1-2 4A
18. Hemorrhoids grade 3-4 3A
19. (peri)anal abscess 3A
20. Perianal fistula 2
21. Anal fissure 2
Others
22. Amebic liver abscess 3A
23. Tetanus 3B
24. Snake or animal bites * -
25. Hipovolemic shock (bleeding) 3B
26. Trauma abdomen * -
Abdominal inspection and palpation 4A
Groin inspection and palpation 4A
Hernia palpation 4A
Psoas sign and obturators sign 4A
Digital rectal examination 4A

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Nasogastric tube insertion 4A
Endoscopy 2
Nasogastric tube suction 4A
Colostomy bag replacement 4A
Enema 4A
Anal swab 4A
Gastroscopy 2
Proctoscopy 2
Ascites sampling 3
Abdominal ultrasound 2
Pediatric surgery
1. Intussuception / Invagination 3B
2. Anal Atresia (anorectal malformation) 2
3. Fistula umbilical, omphalocele,gastroschizis 2
4. Billiary Atresia 2
5. Intestinal Atresia 2
6. Esophageal Atresia 2
7. Hirschsprungs disease 2
8. Hydrocele 2
9. Reponible and ireponible hernia (inguinal, 2
femoral, scrotal)
10. Incarcerated or strangulated hernia 3B
11. Umbilical Hernia 2
12. Undescended testis 2
13. Phymosis 4A
14. Paraphymosis 4A
15. Cystic hygroma 2
16. Hypospadia 2
History taking from third party, or older children, or 4A
anxious parents
General pediatric physical examination 4A
Congenital malformation observation 4A
Pediatric peripheral IV cannulation 4A
Pediatric intubation 3
Oropharynx tube insertion 2
Intraosseus cannulation 2
Circumcision 4A
Airway, breathing management 3
Emergency rehidration 4A

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Plastic surgery
1. Cleft lip and Palate 2
2. Angina ludwig 3A
3. Lacerated wound 4A
4. Perforated, penetrated wound 3B
5. Maxillofacial trauma * -
6. Peritonsillar abscess 3A
7. Hidradenitis supurativa, carbuncle 4
8. Ingrowing toenails 4
9. Ganglion cyst 4
10. Lipoma 4A
11. Burn, 1st and 2nd degree 4A
12. Burn, 3rd degree 3B
13. Burn, chemical 3B
14. Burn, electrical 3B
Infiltration anesthesia 4A
Local nerve block 4A
Topical anesthesia 4A
Wound suturing 4A
Suture removal 4A
Analgesic administration 4A
Incision and drainage of abscee 4A
Excision of benign skin tumor 4A
Wound care 4A
Rozerplasy 4A
Bandaging 4A
Urology
1. Benign Prostatic Hyperplasia 2
2. Urethral rupture 3B
3. Bladder rupture 3B
4. Kidney rupture 3B
5. Torsion of Testis 3B
6. Urethral stricture 3A
7. Varicocele 2
8. Hydrocele 2
9. Urinary stone disease or urinary calculi 3A
10. Priapism 3B
11. Renal colic 3A
12. Asymptomatic urinary tract stone disease 3A
13. Urinary tract infection 4A

20
Bimanual kidney examination 4A
Costovertebral angle tenderness examination 4A
Bladder palpation 4A
Prostate palpation 4A
Bulbocavernous reflex 3
Uroflowmetry 1
Plain abdomen and IVP x-ray interpretation 3
Urethral catheterization 4A
Clean intermitten catheterization 3
Suprapubic puncture 3
Circumcision 4A
Penis, scrotum inspection and palpation 4A
Scrotum transilumination test 4A
Surgical Oncology
Breast disease
1. Breast cancer 2
2. Phyllodes tumor 1
3. Fibroadenoma of the breast 2
4. Mastitis 4A
5. Breast abscess 2
6. Pagets disease of the breast 1
7. Cracked nipple 4A
8. Inverted nipple 4A
Thyroid disease
9. Goitre 3A
10. Thyroid adenoma 2
11. Thyroid cancer 2
Skin disease
12. Nevus pigmentosus 2
13. Malignant melanoma 1
14. Squamous cell carcinoma 2
15. Basal cell carcinoma 2
Others
16. Non-Hodgkins lymphoma 1
17. Hodgkins lymphoma 1
18. Other soft tissue tumors: fibrosarcoma, rhabdo 1
myosarcoma, leimyosarcoma
19. Branchial cyst and fistula 2
20. Tumor lidah * -
21. Tumor rongga / dasar mulut * -

21
22. Lymphadenopathy 3A
23. Lymphadenitis 4A
General and Breast Examination 4A
Self-Breast examination education 4A
Thyroid palpation 4A
Axillary lymphatic node palpation 4A
Salivary gland palpation 4A
Lymph node examination 4A
Orthopaedic surgery
Trauma
1. Open fracture, close fracture 3B
2. Clavicle fracture 3A
3. Pathologic fracture 2
4. Fracture and disclocation of vertebrae 2
5. Extremity disclocation 2
6. Join trauma 3A
7. Achilles rupture 3A
Degenerative
8. Osteoarthritis 3A
9. Osteoporosis 3A
10. Spondilitis 2
Others
11. Primary and secondary bone tumor 2
12. Osteomyelitis 3B
13. Congenital malformation 2
14. Carpal tunnel syndrome 3A
15. Tarsal tunnel syndrome 3A
Gait inspection 4A
Supine-backbone inspection 4A
Moving-backbone inspection 4A
Extremity muscle tone inspection 4A
Extremity join inspection 4A
Inspection of backbone and pelvic postural 4A
Inspection of scapular position 4A
Inspection of spine flexion and extension 4A
Assesment of lumbal flexion 4A
Assesment of flexion, extension, adduction, abduction 4A
and rotation of Hip
Assesment of muscle atrophy 4A

22
Knee: Assesment of cruciate and lateral ligament 4A
Meniscus evaluation 4A
Postural and shape inspection of foot 4A
Dorsal and plantar flexion, inversion, eversion of foot 4A
Palpation for tenderness 4A
Palpation for detection of vertical pressure pain 4A
Palpation of tendon and join 4A
Back bone and muscle, sacro-iliac join palpation 4A
Percussion for tenderness 4A
Evaluation of join ROM (Range Of Motion) 4A
Evaluation of Head ROM 4A
Shoulder join and muscle function test 4A
Wrist, metacarpal, finger join function test 4A
Leg discrapency examination 4A
Close fracture reposition 3
Fracture stabilisation (without casting) 4A
Reduction of dislocation 3
Application of Dressing (Sling, bandage) 4A
Join aspiration 2
Splinter removal 3
Neurosurgery
Trauma
1. Epidural hematoma 2
2. Subdural Hematoma 2
3. Spinal cord injury 2
4. Complete spinal transection 3B
Others
5. Hydrocephalus 2
6. Hernia of Nucleus Pulposus (HNP) 3A
7. Spondylitis TB 3A
Glasgow Coma Scale examination 4A
Vertebral inspection, percussion, and palpation 4A
Skull x-ray interpretation 4A
Vertebral x-ray interpretation 4A
Head CT-Scan and interpretation 2
List of general Clinical Skills:

Skin test 4A
Blood test examination 4A
Plain x-ray interpretation 4A

23
Contrast x-ray interpretation 3
Minor surgery prep: a and antiseptic, local anesthesia 4A
Observer or assistant in major surgery: Scrubbing, 4A
Gowning, Gloving
Patient transport 4A
Basic life support 4A
Mask ventilation 4A
Intubation 3
Fluid resuscitation 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
19. Circumcision

24
20. History taking and physical examination in orthopaedic
21. Wood splinting and bandaging
22. Skin traction
23. Wound toilet and debridement of open fracture
24. 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.
Emergency morning report: student must attend the morning
report every Monday, Wednesday, and Friday at 07:00am.

25
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
the division / department. Each week, the group will rotate to another
division / department, and will have different preceptor following the

26
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).

27
Weekly schedule for each Division / Department
Division of Digestive Surgery

Day Time Activities Place
Mo 06-07 Resident round Ward
07-08 Emergency report Koestedjo room
08-12 Daily activities Clinic or OR
12-13 Break
13-15 BST Preceptor
15-06 Night shift ER
Tue 06-07 Resident round Ward
07-08 Resident presentation Digestive room
08-09 Patients parade Digestive room

28
12-13 Break
13-15 CSS Preceptor
Wed 06-07 Resident round Ward
08-09 Resident case report Digestive room
12-13 Break
13-15 CRS Preceptor
Thu 06-07 Resident round Ward
07-08 Grand round Kemuning L. 4
08-09 General Lecture Koestedjo room
12-13 Break
13-15 Mini-Cex Preceptor
Fri 06-07 Resident round Ward
11-13 Break, Friday pray
Division of Oncology Surgery

Mon 06-07 Resident round Ward
08-09 Patients parade Onkology room
12-13 Break
13-15 BST Preceptor
07-08 Referat Residen Konfrens Onkologi
12-13 Break

29
13-15 CSS Preceptor
12-13 Break
13-15 CRS Preceptor
07-08 Residen presentation Onkology room
12-13 Break
Division of Pediatric Surgery

08-09 Resident presentation Pediatric Surgery room
12-13 Break
13-15 BST Preceptor
07-08 Pediatric EMG Report Pediatric Surgery room
12-13 Break
13-15 CSS Preceptor

30
12-13 Break
13-15 CRS Preceptor
07-08 PatientsParade Pediatric Surgery room
12-13 Break
Division of Plastic Surgery

12-13 Break
13-15 BST Preceptor
07-08 Plastic EMG report Plastic surgery room
08-09 Case report Plastic surgery room
12-13 Break
13-15 CSS Preceptor

31
12-13 Break
13-15 CRS Preceptor
07-08 Referat Residen Plastic surgery room
12-13 Break
08-09 Patients parade Plastic surgery room
Division of Urology
08-09 Patients parade Urology room
12-13 Break
13-15 BST Preceptor
07-08 Urology EMG report Urology room
12-13 Break
13-15 CSS Preceptor

32
12-13 Break
13-15 CRS Preceptor
12-13 Break
Division of Vascular Surgery

08-10 Science session Vascular surgery room
12-13 Break
13-15 BST Vascular surgery room
12-13 Break
13-15 CSS Vascular surgery room

33
12-13 Break
13-15 CRS Vascular surgery room
12-13 Break
13-15 Mini-Cex Vascular surgery room
Division of Orthopaedic Surgery

08-09 Resident presentation Orthopaedic room
12-13 Break
13-15 BST Preceptor
07-08 Orthopaedic EMG report Orthopaedic room
08-10 Grand round Anthurium/Aglonaema
12-13 Break
13-15 CSS Preceptor

34
08-09 Science session Orthopaedic room
12-13 Break
13-15 CRS Preceptor
07-08 Orthopaedic EMG report Orthopaedic room
12-13 Break
Division of Neurosurgery
08-10 Science session Neurosurgery room
12-13 Break
13-15 BST Preceptor
12-13 Break
13-15 CSS Preceptor

35
12-13 Break
13-15 CRS Preceptor
12-13 Break
08-09 Grand round NCCU
Division of Cardiothoracic Surgery

08-09 Patients Parade Cardiothoracic room
09-10 Grand round Ward
12-13 Break
13-15 BST Preceptor
07-09 Resident presentation Cardiothoracic room
12-13 Break

36
13-15 CSS Preceptor
08-09 Grand round Ward
12-13 Break
13-15 CRS Preceptor
07-08 Resident presentation Cardiothoracic room
12-13 Break
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:

37
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
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

38
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
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 Weighted(%) Explanation
1. Scores by preceptor 50% Cumulative of 9
preceptors
- BST 30
- CRS 25
- CSS 25
- Mini-Cex or DOPS 10
- Others 10 Behavior, attitude,
ethics, discipline
(absent), night shift

39
2. Final Examination 50% OSCE
Logbook * *Logbook (filled) is a
requirement for judicium
Professional 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 conversion
Score 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)
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.

40
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.
2. Standard Kompetensi Dokter Indonesia KKI, 2012
Teguh Marfen Djajakusumah 2013

41

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Guidebook

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Profession define as a paid occupation that involves prolongedtraining

The goals of medical clerkship professional education is to create

During hospital clerkship, it is expected that the student practicing the

The scope of surgery is divided into nine division:

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Vision and Mission

Goals of medical education in the field of surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Rotation duration and place

Rules and Sanctions

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Night shift rules

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Exchange / Visiting Medical Student

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Staff and its division and department

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Department of Orthopaedic and Traumatology

Medical student affairs

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Competencies based on Scope of Subject

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Level of Competency 1: recognize and explain

Level of Competency 2: diagnosis and referral

Level of Competency 3: diagnosis, initial management, and referral

Level of Competencies 4: diagnosis and complete independent

In Department of Surgery Hasan Sadikin Hospital, surgery is divided to

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Competencies based on Clinical Skills

Level of competencies 1: Knows and able to explain

Level of competencies 2: Knows how; had seen or demonstrated

Level of competencies 3: Shows; had performed or applied the

Level of competencies 4: Does; perform the skill independently

4A: Achieved the medical skill after graduation

Scope based on competencies (SKDI) and Level

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

List of general Clinical Skills:

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Clinical Skills in pre-clerkship phase

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Chapter IV - Routine activities

Learning and teaching method:

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Supervision and teaching by resident:

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Digestive Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014

Division of Oncology Surgery

Guidebook Medical Student Clerkship Program in Surgery, April 2014