General Surgery
Surgery Program Description
Postgraduate surgical training at the University of Nevada School of provides residents with a broad based training in the surgical sciences. The primary teaching hospital of the program is University Medical Center with 554 beds and home to the only level I Trauma Center in the state. The other major teaching hospital is the Mike O’Callaghan Federal Hospital. The Mike O’Callaghan Federal Hospital (MOFH) is a joint venture between the Department of Veterans Affairs and the Department of Defense’s 99th Medical Group Hospital at Nellis Air Force Base. This facility encompasses 114 beds, with 52 designated for VA use.
The Department of Surgery offers seven first-year positions as a surgical house officer through the National Residency Matching Program. Three of the first-year positions are categorical general surgery positions, three are one-year preliminary positions, and one position is a categorical integrated plastic surgery position matched through the integrated Plastic Surgery Program. The postgraduate surgical curriculum meets and exceeds the guidelines and requirements recommended by the ACGME Residency Review Committee for Surgery and the American Board of Surgery.
The General Surgery program is five years in length and stresses all aspects of diagnostic work-up, preoperative preparation, intraoperative judgment, surgical technique, postoperative management and follow-up care. There are five clinical years with an option of one year dedicated to research available between the second and third years. The wide variety of clinical problems presented at the University Medical Center and the VA at the Mike O’Callaghan Federal Hospital allows each individual an ample opportunity to observe and experience firsthand the complexities of the response of the surgical patient to disease, trauma, and operative intervention.
Goals and Objectives
First Year
The first-year residents (PGY-1) rotate through both hospitals. The PGY-1 resident functions as a member of a surgical care team. Responsibilities include evaluation and planning for treatment of patients; attendance at rounds, clinics and conferences, assisting in the operating rooms.
The operative experience occurs early in this program. The opportunities to assist and perform operative procedures are readily available to the intern. While the junior house officers have significant responsibility, close supervision and backup by more senior house officers and especially the faculty are always present. The high ratio of surgical attending staff to residents and the collegial attitude of the faculty allow above average supervision and support with clinical, operative, and academic activities. PGY-1 residents are expected to assume primary care for patients on their service on a day-to-day basis.
A major goal of the department is to train the resident to understand the principles of pre- and post-operative care. Each resident will meet all ACGME work hour regulations. This is accomplished through a variety of creative scheduling plans including a Night Surgery rotation.
Approximately half of the first year is spent in general surgery while the remaining half is spent on a variety of other rotations with an emphasis in the trauma and intensive care settings. The former includes experience on the three University Medical Center services and at the Mike O’Callaghan Federal Hospital.
Second Year
In the second year (PGY-2), subspecialty exposure one gains outside of General Surgery is introduced to include rotations Plastic Surgery and Otolaryngology. On the General Surgery services, the operating experience extends significantly and involves opening and closing laparotomy wounds, more complicated hernia repairs, and less complicated gastrointestinal and biliary procedures. An increasing amount of clinical independence also is achieved. The rotations are at University Medical Center and the Mike O’Callaghan Federal Hospital.
This year also includes experiences in ICU and trauma rotations but with increasing responsibilities in the operative and non-operative management of the critically ill patient. At the end of this year, the PGY-2 resident will be ready for the transition to making senior level decisions and patient management algorithms.
Third Year
The third year of the program is concentrated in General Surgery and Specialty Surgery exclusively at the University Medical Center. On General Surgery at UMC, the PGY-3 level resident will rotate through all three services: The University Faculty Service (UMC 1), the Clinical Instructor Service (UMC 2), and the Cardiothoracic/Vascular/ Transplant Service (UMC 3).
Fourth & Fifth Years
The fourth and fifth years of the General Surgery training program are designed to provide increasing senior level responsibility in patient care decision making and allow each individual to develop qualities of maturity and judgment which are the essence of the skilled surgical practitioner. The PGY-4 resident continues to supervise perioperative care given by the more junior members of the patient care team. Typical fourth-year rotations include senior level resident responsibility in General, Vascular, and Thoracic surgery at the Veterans Hospital, as well as General, Surgical Oncology, Trauma, Colorectal, Cardiothoracic, Transplant, and Vascular Surgery at the University Medical Center Hospital. During the fourth year, the residents rotate on the Pediatric Surgery service.
The Chief Resident year is spent on the various surgical services dealing with the primary components of general surgery almost exclusively at the University Medical Center Hospital. The chief resident is involved with major elective procedures with emphasis on complex gi, oncologic, endocrine, and complex minimally invasive surgery cases as well as major trauma. The chief resident is responsible for the management of all the patients on his or her service. Requests for surgical consultation from other clinical departments are channeled through the chief resident. During the fifth year, the resident will rotate on Ambulatory Surgery. This is a unique rotation designed to complete the resident’s training in office based practice and outpatient surgery.
The senior resident is required to prepare and present at conferences and is responsible for the teaching and training of more junior house officers and students on his or her service. The final year of the General Surgery experience completes a progressively graded comprehensive training with increasing responsibility and accountability as required by the American Board of Surgery. Chief residents are encouraged to attend at least one major national surgical meeting during their senior year, which is sponsored by the Department.
Evaluation
Each January, all of the residents in the Department of Surgery participate in the General Surgery In-Service Training Examination sponsored by the American Board of Surgery. This test is given nationally by all departments of surgery to evaluate each individual resident's progress. This examination is designed to assess the residents' fund of knowledge in basic science (in the first two PGY years) as it applies to surgery and clinical management (in the remaining three PGY years). This examination is a reasonably accurate predictor of performance in the American Board of Surgery qualifying examination. The Department has set a designated percentile score as an acceptable passing grade.
Each year, the faculty of the Department of Surgery administers a practice oral examination to the residents at the PGY-4 and PGY-5 clinical levels. This Mock Oral Examination is considered an extremely helpful exercise in preparing residents for their certification examination and permits the faculty to identify gaps in a particular resident’s clinical knowledge base.
The performance of each resident in the Department is evaluated by members of the faculty and the Chief Resident on his or her respective rotations. Faculty evaluation records are forwarded to the program director's office via a web based evaluation system. Residents are expected to maintain the standards of the department. The Department follows a team approach to patient care, which includes faculty, chief or senior resident, junior house staff and students functioning with an ascending chain of command, good communication and supervision. Some services require more direct resident/faculty exposure on a preceptor basis. The residents meet with the Program Director every six months to review their performance as part of a "feed-back" process. Residents also have an opportunity to critique the faculty, curriculum and conferences anonymously every six months.
Teaching Conferences
A wide variety of didactic lectures and surgical teaching conferences are available mostly at the University of Nevada School of Medicine Building adjacent to the University Medical Center Hospital. Conferences are attended by faculty, residents, and both junior and senior medical students from the University of Nevada School of Medicine. Visiting professors are scheduled throughout the year and serve as an important external teaching resource.
Protected educational time is provided for all residents every Tuesday from 7 a.m. to 2 p.m. Morbidity and Mortality conference is the first conference each week except for the monthly Grand Rounds. This is followed by a variety of educational activities including; clinical sessions based on the Schwartz surgery text given by the chief residents proctored by faculty, evidence based reviews (journal article review) given by junior residents and attended by faculty, case conferences in general and specialty surgery, thoracic, vascular, and oncology, and selected readings sessions in general surgery. Peppered throughout the year are interdisciplinary grand rounds, guest lectures, and ABSITE review sessions. From 1 p.m. to 2 p.m. on Tuesday is the Skills Lab session that follow a curriculum that will encompass basic surgical skills to laparoscopic skills and including simulation of professional problems in surgery (breaking bad news, patient safety, and team crisis management).
At the beginning of each academic year, new residents in surgery are given the Advanced Trauma Life Support Course and the Acute Cardiac Life Support Course. Each PGY-4 level resident will complete the Fundamentals of Laparoscopic Surgery certification prior to completing the residency.
General Surgery Residency Teaching Conferences and Experiences
Departmental Morbidity & Mortality Conference
Monthly Grand Rounds in Surgery
Clinical Schwartz Text Review Series
Evidenced Based Review of Surgery (Journal Article Review)
Clinical Case Conferences (General/Specialty Surgery, Thoracic Surgery, and Vascular Surgery)
Surgical Skills and Simulation Laboratory Sessions
ABSITE Review
Oral Discussion Sessions (oral problems based review)
General Surgery Teaching Rounds – UMC1 and UMC2
General Surgery Teaching Rounds - VA
Plastic Surgery Conference
Trauma Conference
Tumor Board
Contact for the Residency
Susan Thomas, Surgery Residency Coordinator
(702) 671-2273
sthomas@medicine.nevada.edu
