Program Educational Goals and Objectives
Program Objectives:
The goal of the surgical residency program is to prepare the resident to function as a qualified practitioner of surgery at the advanced level of performance expected of a board-certified specialist. The education encompasses both didactic instructions in the basic and clinical sciences of surgical diseases and conditions, as well as education in procedural skills and operative techniques. The educational process will lead to the acquisition of an appropriate fund of knowledge and technical skills, the ability to integrate the acquired knowledge into the clinical situation, and the development of surgical judgment. The length of the residency program is five clinical years and admission prerequisites are as outlined in the institutional requirements.
The American Board of Surgery (ABS) considers General Surgery to be a discipline encompassing the following content areas:
- Alimentary Tract (including Bariatric Surgery)
- Abdomen wall and its Contents
- Breast, Skin and Soft Tissue
- Endocrine System
- Solid Organ Transplantation
- Pediatric Surgery
- Surgical Critical Care
- Surgical Oncology (including Head and Neck Surgery)
- Trauma and Emergency Surgery
- Vascular Surgery
The expected knowledge and performance of the certified surgeon is as follows:
- Comprehensive clinical knowledge within each area listed, to include epidemiology, anatomy, physiology, clinical presentation, and pathology (including neoplasia)
- Knowledge of the scientific foundations in all areas, including wound healing; infection; fluid management; shock and resuscitation; immunology; antibiotic usage; metabolism; and use of enteral and parenteral nutrition
- Experience and skill in the clinical evaluation, appropriate use of radiologic imaging, and management of diseases within these areas, including diagnosis; indications for surgery and non-surgical treatment; perioperative, operative and postoperative care; and the management of comorbidities and complications
- Extensive experience in minimally invasive surgery for the diagnosis and treatment of diseases in these areas, including basic and advanced laparoscopic procedures
- Substantial experience in diagnostic and therapeutic endoscopy, including colonoscopy, esophagogastroduodenoscopy and bronchoscopy
The following specialty areas are independent of General Surgery; however the certified General Surgeon is expected to be familiar with their common diseases and operative techniques.
- Bariatric Surgery
- Solid Organ Transplantation
- Pediatric Surgery
- Thoracic Surgery
- Vascular Surgery
In addition, the certified general surgeon is expected to be able to recognize and provide early management and appropriate referral for urgent and emergent problems in the surgical fields of:
- Gynecology
- Urology
- Orthopedic Injuries
- Hand Surgery
The certified General Surgeon is also expected to have knowledge of and experience in the following specific areas:
- Resuscitation of critically ill patients, including trauma victims
- Airway intubation, both urgent and elective
- Conscious sedation
- Diagnostic ultrasonography, particularly of the following areas; thyroid and parathyroid, breast, abdomen including intraoperative and laparoscopic ultrasonography, endorectal, trauma including Focused Assessment with Sonography in Trauma (FAST)
- Non-invasive diagnostic evaluation of the vascular system
- Sentinel lymph node mapping for breast cancer and melanoma
The certified General Surgeon is also expected to have knowledge and skills in the management and team-based interdisciplinary care of the following specific patient groups:
- Terminally ill patients, to include palliative care and management of pain, weight loss, and cachexia in patients with malignant and chronic conditions
- Morbidly obese patients, to include metabolic derangements, weight-loss surgery and the counseling of patients and families
- Geriatric surgical patients, to include operative and non-operative care, management of co-morbid chronic diseases, and the counseling of patients and families
- Culturally diverse group of patients.
Specific requirements:
- A minimum of five years of progressive residency education
- All phases of graduate education in general surgery in an accredited general surgery program
- Sixty months of residency training at no more than three residency programs
- No fewer than 48 weeks of full-time clinical activity in each residency year
- At least 54 months of clinical surgical experience with progressively increasing levels of responsibility. No fewer than 42 months devoted to the content areas of general surgery
- Successful completion of Advanced Cardiovascular Life Support (ACLS), Advanced Trauma Life Support (ATLS), Fundamentals of Laparoscopic Surgery (FLS), and Fundamentals of Endoscopic Surgery
- No more than six months during all junior years assigned to non-clinical or non-surgical disciplines
- The entire chief resident experience in either the content areas of general surgery, as defined in section I-D, or thoracic surgery
- Acting in the capacity of chief resident in general surgery for a 12-month period
- The final two years of residency years in the same program
- At least six operative and six clinical performance assessments
Operative Experience:
Minimum of 850 operative procedures in five years
- At least 200 operative procedures in the chief resident year
- A minimum of 40 cases required in the area of surgical critical care patient management
- Residents may count up to 50 cases as teaching assistant toward the 850 operative case total; however these cases may not count toward the 200 chief year cases.
- At least 25 cases as a teaching assistant
1st Year
- Acquire knowledge of basic surgical principles, including ethics, metabolism, hematology, shock, fluid and electrolytes, wound healing, trauma, transplantation, infections and inflammation, anesthesiology
- Learn basic care of the surgical patient: preoperative evaluation, preparation for operation, conduct of operation and postoperative management
- Learn basic surgical techniques: use of instruments, tissue handling, sterile field, laparoscopy
- Perform simple surgical procedures under supervision; serve as surgical assistant
- Develop approach to evaluation of surgical and related conditions in the outpatient (clinic and emergency department) and inpatient setting (consults)
- Understand and begin to model professional competencies
These objectives are accomplished via
- Conferences and assigned reading
- ACLS and ATLS courses
- Fundamentals of Surgery
- Canvas competency curriculum
- Verification of competency curriculum
- Operative skills labs (including open skills, minimally invasive skills and simulation skills)
- Participation in general surgical services and specialty services.
- Perform 100 simple surgical procedures
2nd Year
- Expand knowledge of basic surgical principles
- Perform appropriate surgical procedures under direct supervision
- Become more independent in the management of the surgical patient
- Increase participation in decision making
- Learn advanced surgical techniques
- Understand care of critically ill patients, including trauma/burn
- Acquire knowledge of organ specific diseases and their management
- Display professional competencies
These objectives are accomplished via
- Conferences and assigned reading
- Successful completion Part 3 USMLE
- Operative skills lab (including open skills, minimally invasive skills and simulation skills)
- Participation in surgical services, including Trauma/Critical Care
- Perform 250 surgical procedures
3rd Year
- Expand knowledge of basic principles; can teach students and less experienced residents
- Perform more advanced surgical procedures with direct supervision
- Function independently in patient management
- Assume leadership responsibility on surgical service
- Be proficient in performing surgical procedures, e.g. line placement
- Expand knowledge of organ specific diseases, particularly in Pediatric Surgery, Cardiothoracic Surgery and Transplant
- Assume responsibility for care of critically ill patients
- Become proficient in endoscopic procedures
- Display professional competencies
These objectives are accomplished via
- Conferences and assigned reading
- Operative skills lab (including open skills, minimally invasive skills and simulation skills)
- Endoscopy and rural rotation
- Role as senior resident on assigned services
- Rotation in Pediatric Surgery, Trauma/Critical Care, Transplant
- Perform 200 surgical procedures
4th Year
- Expand knowledge of surgical procedures
- Expand knowledge of organ specific disease and management
- Become proficient at performing common general surgical procedures with supervision
- Gain experience in private practice setting
- Become proficient at overall care of trauma/critical care patients
- Develop advanced minimally invasive surgical skills
- Function independently in patient management
- Assume leadership role in Residency Program
- Become experienced educator of students and residents
- Display professional competencies
These objectives are accomplished via
- Conferences and assigned reading
- Operative skills lab (including open skills, minimally invasive skills and simulation skills)
- Colorectal rotation with endoscopy experience
- Senior resident on general surgical service at private hospital
- Senior resident in trauma/critical care service
- Perform 200-250 surgical procedures
- Participate in Mock Oral Exam
5th Year
- Strong comprehension of surgical principles
- Extensive knowledge of organ specific disease and management
- Proficient at performing general surgical procedures and meets all volume requirements
- Function independently in patient management and during procedures
- Function as leader of surgical team, including education components
- Has leadership role in Residency Program
- Display professional competencies
These objectives are accomplished via
- Conferences and assigned reading
- Administrative responsibilities
- Completion of scholarly project
- Operative skills lab (including open skills, minimally invasive skills and simulation skills)
- Successful completion of Fundamentals of Laparoscopic Surgery
- Participate in Mock Oral exam
- Participate in Mock Written exam every quarter
- Chief resident on general surgical services
- Performs 200-250 surgical procedures
- Meets all applicable ACGME operative experience requirements