The Department of General Surgery at Carolinas Medical Center (CMC) offers a broad educational experience for all residents. This includes extensive operative experience (total 850 to 1,100) in all categories of surgical procedures over five years); varied experience in an active, outpatient clinic setting; and a variety of teaching conferences directed by resident physicians and attendings. Resident physicians work with all full-time faculty and with many community physicians who participate in the general surgery teaching program.
Responsibility is progressive as residents move through the program, ending with the chief year, during which residents take full responsibility for the surgical service. Each chief resident takes responsibility for serving as the administrative resident. The administrative chief disseminates information to the residents, is a resident liaison at faculty meetings, and coordinates many activities of the general surgery resident staff.
Clinical experience is gained primarily at CMC, with a one-month rotation at CMC-Mercy Hospital (less than one mile from CMC) during PGY-4 and two months during PGY-5. Resident physicians receive extensive training in all aspects of general surgery including laparoscopic techniques, trauma surgery, transplant surgery, surgical oncology, hepato-pancreatico-biliary surgery, endocrine surgery, vascular surgery, pediatric surgery and surgical critical care.
Residents and faculty conduct general surgery clinic, endoscopy clinic and trauma clinic once a week. Pediatric surgery clinic is also held weekly. Daily work rounds are conducted by each service, and the attending surgeons participate in teaching rounds with the resident staff. One of the services (Red) is devoted to hospital consultation and complex urgent surgical cases (non-trauma), elective surgery consultations, and the surgical clinic cases. A new emergency general surgery (EGS) service is responsible for Emergency Department consultations for non-traumatic general surgery patients.
General surgery residents have an exceptional opportunity for transplantation and vascular access experience with rotations totaling three months at CMC's Transplant Center. Our chief residents graduating during the 2010-2011 academic year averaged eight transplant operations as resident surgeons as well as multiple vascular access procedures.
The Transplant Center offers the following programs:
- Kidney Transplant Program including laparoscopic live donor
- Liver Transplant Program (adult and pediatric)
- Kidney/Pancreas and Pancreas-after-Kidney Transplant Program
Training in basic and advanced laparoscopic procedures is an integral part of the residency program. Surgical endoscopy is emphasized throughout the entire residency with significant experience at each level of training, including flexible sigmoidoscopy, EGD, colonoscopy, and therapeutic endoscopy.
Under the Department of General Surgery, the multi-disciplinary program for minimal access surgery, Carolinas Laparoscopic and Advanced Surgery Program (CLASP), was developed in 1997 to create a clinical and research institute at CMC. It includes all specialties involved in minimal access surgery. This program has greatly added to the patient referrals requiring advanced laparoscopic surgery and has facilitated the creation of two two-year fellowships in laparoscopic surgery.
General surgery residents and the laparoscopic fellows share ample laparoscopic experience during their training. The fellows, who are junior attendings, work closely with our surgical residents in caring for patients requiring laparoscopic surgical procedures. Surgical residents also benefit by their involvement in clinical and basic science research including writing and publishing of peer-reviewed articles and book chapters. Another important function of CLASP is to maintain a simulation laboratory where residents can develop skills in laparoscopic surgery before experience in the operating room. A facility-wide simulation laboratory under the direction of a full-time surgical faculty member has also been created.
Teaching conferences are offered throughout the week for general surgery residents and residents rotating from other departments. The following conferences are required:
- Basic science (once a week)
- Grand rounds including visiting professors, surgical grand rounds and multidisciplinary trauma conference (each once a month)
- Morbidity-mortality/quality assurance (once a week)
- Journal club (once a month)
- Core competency conferences (throughout the year)
Protected time is set aside each Thursday morning for resident conference attendance and simulation laboratory work.
Other conferences include:
- Multidisciplinary trauma/critical care conference
- Multidisciplinary cancer conference
- GI cancer conference
- HPB treatment planning conference
- Breast conference
Instructional Courses Available to Residents
Instructional courses are held throughout the year under the direction of members of the Department of General Surgery. Laparoscopic skills courses provide residents with the opportunity to practice laparoscopic procedures in a laboratory setting. These additional courses are available for community physicians as well as house officers:
- Laparoscopic approaches to morbid obesity
- Laparoscopic and hand-assisted colorectal surgery
- Percutaneous tracheostomy
- Inferior vena cava imaging and filter insertion
- Flexible gastrointestinal endoscopy
- Advanced trauma life support
- Pediatric advanced life support
- Advanced cardiac life support
- Fundamental critical care support
General surgery residents are granted five work days per year to attend an approved educational meeting. All meeting determinations are made at the beginning of the academic year. The meetings attended by residents include general surgical meetings such as the American College of Surgeons Clinical Congress and the Southeastern Surgical Congress; trauma meetings such as the American Association for the Surgery of Trauma; as well as colon and rectal, transplant, and vascular national meetings. Each resident is provided with an additional $1,900 per year to cover organizational dues, books, journals and meeting travel.