General Surgery Residency
Curriculum
- PGY1 Year
This "intern" year of the residency is used to build the foundation of the program and introduce the residents to the services which they will be working during their time at Carilion Clinic. A recent addition to this year is the Introduction to Research rotation, which will allow the residents to understand the research process and begin at least one research project that is expected to yield a paper and a presentation at a program at a regional or national level. Finally, it is expected that the resident will be able to perform basic operations such as hernia repair and laparoscopic cholecystectomy.
- PGY2 Year
During their second year, each resident will assume the role of junior resident on each of their services as well as run the ICU service at night and conduct initial evaluation of all patients in the ER. Experience in the operating room will include operating on more difficult cases, such as acute cholecystitis, and in general will continue to develop.
- PGY3 Year
A critical year for the resident, the third year of the program allows for the experience of a leadership role at Carilion Clinic. Under the supervision of attending staff members, the resident will be chief of their Trauma, ICU, Pediatric and Thoracic services as well as getting generous exposure to General Surgery in a more advanced role.
- PGY4 Year
During the fourth year of the program, the resident will begin to assume a more senior level of management such as Chief of Trauma, Night Float, Vascular Services.
- PGY5 Year
The final year of the program allows for the resident to experience the complex nature of surgical decision-making at Carilion Clinic as the senior resident on most services, specifically Emergency General Surgery, as well as the two elective general surgery services and at the separate community hospital.
- Call Policies
Night float services cover Sunday through Thursday night leaving Friday night and Saturday being only 24-hour calls. Sunday day is also covered as a “call.” The remaining rotations have a frequency of in-hospital call that, viewed across those rotations, averages less than one in 7 days. As one should expect from any resident training program, all AGGME-established guidelines for work hours are readily met and exceeded. Average call is less than 2 shifts in 4 week block.
- Operative Experience
General surgery residents are exposed to a tremendous surgical experience in terms of breadth and complexity of operative cases. The teaching faculty members are committed to allow qualified residents to perform these operations procedures as chief operative surgeons. Average total for our graduates of our program have conducted an average of 1,100 major operations, 250 major cases as surgeon chief and 70 as teaching assistant. These totals roughly correspond to > 50 percentile in total major operations and surgeon chief cases and > 85 percentile for TA cases.
Elective Rotations
| PGY 1 | PGY 2 | PGY 3 | PGY 4 | PGY 5 |
|---|---|---|---|---|
| Oncology/complex General Surgery (Berry Service) | MIS/Bariatric | Pediatric Surgery | Oncology/complex General Surgery | Oncology/complex General Surgery |
| MIS/Bariatric (Davies Service) | Colorectal | Thoracic | Head & Neck | MIS/Bariatric |
| Colorectal (Fogel Service) | Breast Oncology | Oncology/complex General Surgery | Trauma | Emergency General Surgery |
| Emergency General Surgery (Ferrara Service) | ICU Nights | Transplant | Night Float | Carilion New River Valley Hospital |
| Vascular Surgery | Endoscopy | ICU Chief | Breast Oncology | Colorectal |
| Trauma (Gilbert Service) | Emergency General Surgery | Head & Neck | Vascular Surgery | |
| ICU | Night Float | Carilion New River Valley Hospital | Thoracic | |
| Night Float | Carilion New River Valley Hospital | Elective | ||
| Endoscopy | ||||
| Anesthesiology | ||||
| Pediatric Surgery | ||||
| Intro to Research |
Didactic Sessions
- Conferences
An "education first" philosophy has been established by voluntary faculty and residents alike within the Carilion General Surgery Residency. As such, all residents can attend the following morning conferences, held at Carilion Medical Center. The overarching guideline of the conference schedule is to deploy fundamental didactic surgical curriculum around which we will deliver a higher-level curriculum via more Socratic methodologies.
- Basic Science Conferences
To prepare residents for the American Board of Surgery (ABS) qualifying examination (and, of course, the annual ABSITE examinations) a weekly review following the This Week in the Surgical Council on Resident Education (SCORE) curriculum will be moderated by the program director and select faculty. The material learned in that session will be later reinforced by a multiple-choice examination delivered in the format of an interactive, audience-response, facilitated discussion session we call the Evidence-Based Medicine Conference.
- Surgical Skills Curriculum
One week per month we deliver a multifaceted curriculum that will include, but not be limited to, the following:
- Fundamental simulation training exercises such as suturing, knot tying, laparoscopic skills enhancement
- Trauma team STEPPS training
- Virtual operating room team training
- Simulated surgical gesture proficiency analysis
- Fundamentals of surgical critical care
- Problem-based learning in ethical decision making
- Bedside ultrasound-training facilitated patient management scenarios in trauma, general and vascular surgery
- Facilitated journal club (selected readings in General Surgery)
- Simulated bedside procedures (thoracostomy tube, central line, intubation, etc.)
Another facet of the skills curriculum is an intern Boot Camp which occurs during the first 2 months of the academic year. The purpose of this Boot Camp is to introduce the incoming residents to laparoscopic operations and skills as well as how to handle clinic and operative scenarios.
- Surgery Grand Rounds
Interspersed with the more traditional format of weekly Surgical Grand Rounds, given by experts in their fields, the surgery residents can expect to deliver grand rounds during their chief year, each one supervised by a faculty mentor who is trained to provide insight as to the proper conduct of a formal presentation. In so doing, it is our intent to assure that our graduates are given the skills needed to impart medical information to others—professionals and lay public alike.
- Morbidity and Mortality Conference
The Morbidity and Mortality conference is the most important teaching conference a training program can conduct. We have specifically designed our M&M conference to encourage the residents to take a proactive role in analyzing each complication.
- Chairman’s Rounds
A case presentation didactic conference with the department chair covers common surgical problems and is divided into junior and senior resident sessions.
- Breakout Conferences
In these sessions, attendance is encouraged by those residents who are rotating on that given specialty for which the conference is designed. These conferences represent unique opportunities to enhance one's clinical skills within the scope of that conference. Sessions include:
- Combined Emergency Department/Trauma conference
- Breast Treatment Planning conference
- Tumor Board (New River Valley Hospital)
- Trauma/ICU conference
- GI Tumor Board
- Vascular Arteriogram Conference
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