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. We just received approval from the General Surgery Residency Review Committee to increase our cohort to 6 categorical residents, which will start in July 2018. Elective opportunities for basic and clinical research are also available as part of the residency program. We offer research positions within our institution, but some of our residents choose to get research experience at other universities across the United States.
University Hospital (a 409-bed, Level I Trauma Center, and Golisano Children's Hospital) and Upstate University Hospital at Community General (a 326 bed hospital) provide exposure to busy general surgery services.
Our hospitals serve 17 counties in the Upstate and Central New York area. Operating room include both adult and pediatric capabilities. 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.
Clinical duties are performed at not only University Hospital, but also several community hospitals including the Syracuse Veteran's Affairs Hospital. This broad exposure to different health-care delivery models provides a balanced and complete educational experience as well as interaction and training from a wide variety of surgeons in all types of practice.
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 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. Located about 2 miles from Upstate, this hospital provides rotations in vascular 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 all five clinical years of our residency program conform to that "blueprint."
During the first two years of training, approximately three-quarters of the rotations are devoted to general surgery and its principal components, with experience in Critical Care, Trauma, Consults, and the SICU. Rotations at the VA and Crouse hospitals constitute the remaining quarter.
In the third, fourth and fifth years, rotations include Advanced Laparoscopic, Pediatric, Vascular, Thoracic, and Transplant Surgery and well as Acute Care, Trauma, and rotations at the VA, Crouse. Additionally, chief residents will rotate through St. Joseph's Hospital.
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:
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.
For the categorical residents, the rotations, while slightly different from resident to resident, provide an equivalent experience during each year of training.
For the intern 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 non-designated preliminary residents, the rotations are similar to the categorical general surgery residents unless specific requirements are necessary for continued training in different specialties.
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 will allow you to progress toward personal, as well as, professional goals.