The main focus of a residents education is exposure to a broad variety of clinical conditions and operations, but as surgical educators, we should not rely on "random opportunity" to define the surgical curriculum.
We should instead strive to enhance the educational value of rotations through informal teaching sessions, rounds, and clinic time with special attention to learning opportunities presented by patients.
The Department of Surgery at SUNY Upstate Medical University offers a traditional, comprehensive, fully ACGME accredited general surgery residency program with a curriculum emphasizing supervised experience in both traditional, open surgical procedures and newer, laparoscopic, minimally invasive and robotic techniques. Elective opportunities for basic and clinical research are also available as part of the residency program.
University Hospital, a 409-bed, Level I Trauma Center, and Golisano Children's Hospital serve 17 counties in the Upstate and Central New York area. Operating room capabilities include 17 operating rooms (adult and pediatric). Surgical services include General Surgery, Acute Care Surgery, Advanced Laparoscopic Surgery, Bariatric Surgery, Breast Surgery, Burns, Colorectal Surgery, Hepatobiliary Surgery, Pediatric Surgery, SICU, Thoracic Surgery, Thyroid Surgery, Trauma, Transplant Surgery, and Vascular Surgery. Resident teams also rotate through the general surgery teaching services at affiliated hospitals nearby.
Crouse Hospital, nearby Veterans Administration Hospital, St. Josephs Hospital Health Center and .
Clinical duties are performed at not only University Hospital but also several community hospitals and the Syracuse Veteran's Affairs Hospital. This broad exposure to different health-care delivery models provides a balanced and complete educational experience, but also offers interaction and training from a wide variety of surgeons in all types of practice.
Upstate University Hospital at Community General: A 326 bed hospital, provided exposure to a busy general surgery service covering many of the "bread and butter" general surgery cases in Syracuse.
Crouse Hospital: A 570+ bed community hospital physically connected to University Hospital provides a wide range of surgical services and includes a 50 bed neonatal intensive care unit. Surgical services covered include General Surgery, Hernia, Gallbladder, Thyroid, Breast, and Intestinal Surgery.
Syracuse Veteran's Affairs (VA) Hospital: A 106 bed, full-service Veteran's Hospital provides surgical rotations encompassing general, vascular, and thoracic trauma in a unique patient population.
St. Joseph's (St. Joe's) Hospital: A community hospital with centers of excellence in vascular surgery and cardiac health, this private hospital, located about 2 miles from University Hospital provides rotations in vascular surgery and colorectal surgery. The vascular rotation is particularly busy with 5 surgeons and some of the highest numbers of carotid endarterectomies and peripheral bypasses in Upstate New York.
The Accreditation Council in Graduate Medical Education (ACGME) specifies, in considerable detail, what clinical experiences must be included in a general surgery residency program; the rotations in the five clinical years of our residency program conform to that "blueprint."
During the first two years of training, about half of the rotations are devoted to general surgery and its principal components (e.g. trauma, vascular surgery, etc.) with experience in surgical specialties and other (e.g. Critical Care) specialties constituting the remaining half.
In the third, fourth and fifth years, about two-thirds of the time is spent on general surgical services; the other rotations include components of general surgery, such as transplant, pediatric and vascular surgery.
Residents are assigned progressive responsibility for patient care by the supervising attending physician and the surgery Program Director/Chair, based on faculty evaluations of clinical competence, including:
Promotion and assignment to progressive patient care responsibilities requires satisfactory completion of the training objectives specific for each PGY year as assessed by the faculty. Operative experience under supervision is provided and stressed at all levels of the residency.
The resident progressively acquires more extensive knowledge of surgical physiology, develops technical skills and gains a thorough understanding of the aims, attitudes and philosophies of surgery. As a PGY-5, each chief resident, while working along side of the attending surgeons, is in charge of his/her own service, exercising major independent responsibility.
The rotations for the categorical residents, while slightly different from resident to resident, provide an equivalent experience during each year of training.
For the preliminary residents in orthopedics, ENT, neurosurgery and urology, the rotations have been tailored to fit within the requirements established by the specialty boards governing those training programs. For the most part, the rotations for the non-designated preliminaries are similar to the categorical general surgery residents unless specific requirements are necessary for continued training in different specialties (i.e. radiology or anesthesiology).
It is not difficult to imagine the challenges dominating five or more years of clinical training. But they need not, and should not, be all-consuming. Friends and family, rest and recreation, enjoyment of the arts, and service to the community are no less important because you are a resident. Indeed, during this portion of your career, when time is perhaps your most precious commodity, it is vital that you strike a balance in your life that allows you to progress toward personal, as well as, professional goals.