The surgical curriculum of the General Surgery Residency Program at Carolinas Medical Center has been developed to increase a resident's responsibility as he/she moves through the program. During the chief resident year, the resident takes full responsibility for his/her surgical service. Each post-graduate year is structured to build on the skills developed in previous years of training. PGY-1 through PGY-4 residents on the General Surgery services are on call an average of eight nights a month. During PGY-1 through PGY-4, call is in-house. During PGY-5, call is home beeper call. In all rotations, the guidelines of the ACGME 80-hour work week are followed.

The non-categorical PGY-1 resident completes six months on the Trauma service, five months on one of the General Surgery services and one month on the Neurosurgery service.

PGY-1
Each categorical PGY-1 resident completes two months on each of the three General Surgery services and three months on the Trauma service. The resident is introduced to the basic elements of care of the surgical patient. Instruction on these services includes conducting a comprehensive history and physical examination, evaluation of the patient's problem and establishment of a plan, ordering appropriate laboratory tests, radiological tests and medications, preoperative and operative care at the PGY-1 level, postoperative care of the patient, and patient care in the outpatient facility. PGY-1 residents attend daily rounds directed by the chief resident of the service, attend faculty attending rounds several times a week, and participate in several teaching conferences throughout each month which may include Board Review Conference, Basic Science Conference, M&M/QI Conference, Tumor Board and Visiting Professor Grand Rounds.

The Red Surgical Service has been developed to care for the unassigned emergency surgical (non-trauma) patients and the patients seen in the Surgical Clinic at CMC-Myers Park. The PGY-1 residents on this service participate fully in the evaluation and operative management of these patients.

The General Surgery Blue Service emphasizes gastrointestinal surgery and minimal access surgery. As part of this emphasis, PGY-1 residents on the Blue Service master simple endoscopic procedures, learn about gross interpretation of various GI radiographs in discussions with the attending surgeon, and demonstrate ability to examine, diagnose, and develop care and treatment plans for patients with GI and anorectal diseases. The residents participate in basic and advanced laparoscopic procedures.

The emphasis of the General Surgery Gold Service is surgical oncology, surgical endocrinology and management of hepatic and pancreatic disease under the direction of the Director of Hepatopancreatobiliary Surgery. Interns on this service master diagnostic and simple operative skills related to patients who have certain types of cancer. The residents also participate in the Endoscopy Clinic on Thursday afternoons.

Three months of Trauma Surgery are included in the first post-graduate year. While on the Trauma Service, PGY-1residents learn simple surgical procedures performed in the Emergency Department or at the bedside and participate in the resuscitation of injured patients. Extensive clinical experience is gained in trauma patient evaluation, pre- and post-injury care, and critical care in the Trauma ICU.

Each resident in the surgical residency program is evaluated monthly by the chief resident of the service and by attending physicians assigned to the service.

One-month rotations in Neurosurgery, Orthopedic Surgery and Pediatric Surgery are also included in PGY-1.

PGY-2
Post-graduate year two also includes two months on each of the three General Surgery services, two months of Transplant Surgery, two months of Trauma/Critical Care, and two months divided among the Plastic Surgery, Gynecology Surgery, and Anesthesia services.

The PGY-2 house officer assumes the role of intermediate resident on each of the three General Surgery teams. For the General Surgery Red Service, specialized skills are developed in the care of the emergency surgical (non-trauma) patient. While on the General Surgery Blue Service, intermediate residents manage and operate on patients with GI and anorectal disease. PGY-2 residents on the General Surgery Gold Service perform breast and other types of biopsies, care for patients who have melanoma, breast and colon cancer, and assist with surgical operations on patients with cancer. Residents also learn endoscopic techniques during the Thursday Endoscopy Clinic.

The PGY-2 surgical resident on the Trauma/Critical Care Service learns:

• Initial resuscitation of the acutely injured patient
• Indications for mechanical ventilation
• Basic pulmonary physiological concepts related to ventilation
• Cardiovascular physiology
• Details of head and spine injury
• Principles of nutritional support
• Cause, prevention and management of ARDS and MOSF
• Performance of many procedures in the ICU

PGY-2 house officers assigned to the Transplant service learn the basics of organ procurement and of immunosuppressive drugs, their use, and their complications, and assist with preoperative and postoperative care of transplant patients.

PGY-3
The third post-graduate year consists of six months on the General Surgery services, two months on the Trauma/Critical Care service, two additional months on the Transplant service, and one month each on Urology Surgery and Cardiothoracic Surgery. The General Surgery Red, Blue and Gold Services concentrate in the same areas listed previously. Surgical residents are given increasing responsibility in patient care and operative experience and oversee and teach junior residents and medical students.

PGY-4
During the fourth year of surgical residency, each resident serves four months as chief of the Trauma Surgery service, four months as chief of the Pediatric Surgery service, and four months concentrating on developing skills in Vascular and Thoracic Surgery.

In addition to these responsibilities, each PGY-4 house officer is given the option to travel to San Jose, Costa Rica, and work for one month gaining experience in the treatment of gastric cancer and in the technical issues relating to gastric resection.

PGY-5
The PGY-5 house officer becomes adept at managing all aspects of surgical care in final preparation for functioning as an independent practitioner of surgery. Each of the three surgical chief residents manages the three General Surgery services for four consecutive months during the academic year.