The curriculum of the General Surgery Residency Program at Carolinas Medical Center has been developed to increase a resident's responsibility as he or she moves through the program. During the chief resident year, the resident takes full responsibility for 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 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.
Each categorical PGY-1 resident completes two months on each of the three general surgery services and two months on the trauma service, and one month in the Trauma Intensive Care Unit (critical care). The resident is introduced to the basic elements of surgical patient care. Instruction includes conducting a comprehensive history and physical examination; evaluating the patient's problem and establishing a plan; ordering appropriate laboratory tests, radiological tests and medications; preoperative and operative care at the PGY-1 level; postoperative care; and patient care in the outpatient facility.
PGY-1 residents attend daily rounds directed by the service's chief resident, attend faculty attending rounds several times a week and participate in several teaching conferences throughout each month. Conferences may include board review conference, basic science conference, M&M/ QI conference, tumor board and visiting professor grand rounds.
The acute care general surgery (red) service cares for the unassigned emergency surgical (non-trauma) patients and the patients seen in the surgical clinic at CMC-Myers Park. The Endoscopy Clinic is also covered by the red service residents and PGY-1 residents participate fully in this clinic.
The general surgery blue service emphasizes gastrointestinal surgery and minimal access surgery. As part of this emphasis, blue service PGY-1 residents master simple laparoscopic procedures; learn about gross interpretation of various GI radiographs in discussions with the attending surgeon; and demonstrate the 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. PGY-1 residents on this service master diagnostic and simple operative skills related to patients who have certain types of cancer.
Two months of trauma surgery are included in the first post-graduate year. While on the trauma service, PGY-1 residents participate in 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 PGY-1 resident completes a one-month critical care rotation.
Each resident is evaluated monthly by the service's chief resident and by attending physicians assigned to the service.
Rotations in neurosurgery/urology, orthopedics, and pediatric surgery are also included in PGY-1 experience.
Post-graduate year two also includes six months on the general surgery services; two months of transplant surgery; two months of trauma/ critical care, one month divided between plastic surgery and GI surgery, and one month divided between the GYN and gynecologic oncology 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. Residents also learn endoscopic techniques during the Thursday endoscopy clinic. 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 procedures; care for patients who have melanoma, breast and colon cancers; and assist with operations on patients with other cancers. 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.
The third post-graduate year consists of six months on the general surgery services, two months on the trauma/ critical care service, two months on the vascular service, a one month elective and one month of transplant 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.
During the PGY-4 year, each resident serves four months as chief of the trauma surgery service, four months as chief of the pediatric surgery service, one month concentrating on developing skills in vascular and thoracic surgery, one month concentrating on colon and rectal surgery and one month on the red service serving as the red service clinic chief.
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.
The PGY-5 year includes 11 months of general surgery as the chief resident on one of the general surgery services. This includes teaching and supervising junior residents and medical students. In addition, one month will be spent completing a mini-fellowship in advanced laparoscopic surgery. During this year, chief residents gain extensive experience in complex surgical cases.