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General Surgery

Program Structure

Categorical Residents
Five categorical residents are accepted into the General Surgery Program and will track thru the PGY-1 to PGY-5 years. Given acceptable clinical and academic performances all five residents are expected to complete the Chief Residency experience (PGY-5).  One or two years of basic science or clinical research may be arranged commencing at the end of the PGY-2 training year. This leave must be arranged with the Office of Surgical Education one year prior to the intended absence.

Junior Resident
Each Junior Resident will rotate for 4-week periods through all of the primary, secondary and tertiary areas in general surgery and for 4-week periods in plastic surgery, and cardiothoracic surgery. Goals and objectives for each clinical rotation have been established. These are provided to guide both the resident and rotation coordinator in what is expected both cognitively and procedurally from each clinical rotation. In addition, the ACGME has mandated a series of general and specific competency-based knowledge/performance objectives for resident training in General Surgery. Junior Residents are responsible for the day-to-day care of the surgical patients on the services to which they are assigned, supervised by Senior Residents, Chief Residents and Attending Surgeons. The emphasis of this two year experience is a mastery of the pre-and post operative care of the surgical patient. Introduction to operative surgery, both open and laparoscopic, is provided.

Each Junior Resident (categorical) can expect rotation assignments to the following clinical areas:

PGY-1 & PGY-2
General Surgery (1&2)
Acute Care Surgery (includes Trauma)
Transplant Surgery
Vascular Surgery
Veterans Administration Medical Center
Plastic Surgery
Cardiothoracic Surgery

Senior Resident
The Senior Resident is responsible for the oversight of the Junior Resident activity on the service to which he/she is assigned, supervised by an Attending Surgeon. The Senior Resident also acts as a clinical instructor for the medical students assigned to the surgical clerkship. Significantly, the Senior Resident plays a progressive role in the surgical decision making process and the subsequent operative procedure.

Each Senior Resident (PGY-3 & PGY-4) will rotate thru the following principle areas:

General Surgery VAMC
Acute Care Surgery AMC  (includes Trauma)
Pediatric Surgery AMC
Minimally Invasive Surgery AMC 

Transplant Surgery AMC
General 1 AMC
Vascular Surgery AMC
Thoracic Surgery SPH
General 2 AMC

Chief Residents
The Chief Resident functions as a junior attending surgeon and is primarily responsible -- under Attending Surgeon oversight -- for all aspects of care of selected complex patients. Teaching and administrative activities round out this Chief Resident experience.

Each Chief Resident (PGY-5) will be assigned as follows:

Acute Care Surgery - AMC (General)
Acute Care Surgery- AMC (Trauma/ Administrative)
General Surgery 2- AMC
General Surgery 1 / Pediatric Surgery /MIS/ Transplant- AMC

Operative Experience
The residency review committee has emphasized the importance of resident involvement in all aspects of care of the surgical patients. To quote, "Doing the operation is not surgical education."  The resident must be involved in initial patient evaluation, pre-admission work up, admission procedures, pre-operative, and post-operative care, as well as post-discharge evaluation and care. Only in this way can a resident gain insight and skill in all those aspects of the delivery of surgical care required of the contemporary surgeon.

To this end, residents at all levels are required to participate in all aspects of patient care and to document the same.

Office Experience
So much of what a general surgeon does today occurs outside the hospital setting.  The Residency Review Committee encourages significant office participation by residents at all levels. Residents are mandated to attend the office hours of the attending surgeons with whom they work. This enables the resident to view the scope of General Surgery activities that occur outside the operating room and inpatient hospital setting. This also ensures a continuity of care, highly prized in surgical training.