Lectures and Tutorials
Tuesday Mornings - 7 a.m. 7:50 a.m.
On the first Tuesday of each calendar month, Dr. Burgoyne (Assistant Residency Program Director) meets with the residents and medical students to discuss general surgery topics. Topics such as exocrine pancreas, skin malignancies and hernias are assigned ahead of time to enable residents to read about the topic and contribute to the discussion.
On the second and fourth Tuesday, Dr. Gashti (Chief of Vascular
Surgery) and Dr Ulloa (Vascular Surgery) respectively, meet with
the residents and medical students to discuss vascular surgery
topics. Topics such as cerebrovascular disease, aneurysms and
dialysis access are assigned beforehand so residents can read
ahead of time and answer questions during the discussion.
On the third Tuesday, senior residents are assigned to present
lectures on basic sciences in preparation for the ABSITE. The
topics include wounds, healing, transplant, oncology, critical
care. These lectures are followed by a question and answer
session. Specialty attendings alternate months with the residents
and these lectures cover the following specialties: urology,
neurosurgery, trauma and ENT.
Wednesday Mornings - 7 a.m. to 7:50 a.m.
Each Wednesday morning Dr. Skaryak meets with the residents and
medical students for a clinical discussion. Residents present a
current surgical case that requires complex surgical care and
decision making. The discussion centers around the patient's
clinical presentation, diagnosis and workup as well as management
Friday Mornings - 7 a.m. to 11 a.m.
Each Friday, Morbidity and Mortality Conference begins at 7 a.m.
(see below). Protected teaching time is from 7 a.m. to 11 a.m.
and content varies week to week.
- For two out of four weeks, residents are assigned by level of
seniority to meet with different attendings for Small Group
Tutorials. These tutorials are in the "Oral Board" format on the
assigned surgical topic and are appropriate for the resident's
- Also for two out of four weeks, residents present material
and answer the questions assigned for that week in the SCORE
- Closer to the ABSITE, topics not covered during Tuesday
morning conference are lectured on during the Friday teaching
block. In addition, question and answer series are presented to
prepare residents for the ABSITE each January. Residents are also
given a recommended reading schedule to assist them in preparing
for both the ABSITE and board exam. Topics are selected to focus
on high yield questions and information.
- Basic Science lectures are given by respective attendings on
topics such as pathology, radiology, pharmacology, infectious
diseases and various organ systems.
- Cadaver labs are held (see below).
- Clinical Simulation is held monthly at MedStar Harbor
Hospital's Clinical Simulation Lab (see below).
- Integration of other healthcare resources at our hospital to
better facilitate patient care. These lectures include physical
and occupational therapy, rehabilitation medicine, speech
language pathology, the pain management service, dietitians and
lectures in ethics.
Tumor Board is held in the MedStar Union Memorial Hand Center on
Wednesday at noon. Breast tumor board alternates weekly with
general oncology cases. In attendance are representatives from
medical oncology, radiation oncology, surgery, radiology,
pathology and medicine. The conference facilities permit
projection of radiology and pathology findings. Evaluation,
staging, treatment options, and results of treatment are
discussed. The conference is a CME accredited meeting.
Department of Surgery Morbidity and Mortality Conference
Every Friday morning from 7 a.m. to 8 a.m., weekly morbidity and
mortality is discussed. The surgical Mortality and Morbidity
Conference is accredited by the Medical and Chirurgical Faculty
of Maryland as a Category One credit of continuing medical
education. In attendance are the medical students, surgical
residents, general, vascular, thoracic surgical attending staff
and medical students. All weekly mortality and relevant morbidity
is discussed. Cases are presented by the chief resident on the
service, then the discussion is open to the group. The following
topics are targeted for discussion:
- What is the complication?
- What does the literature state is the occurrence of this
complication? If a death, what does the literature state is the
expected mortality for that procedure or disease process?
- What, if anything, do the responsible physicians feel they
would do differently in the future? Do any changes in our process
of care of patients need to be implemented?
The third Friday of the month after the Mortality and Morbidity
Conference, PGY-4 and 5 residents meet with the program director
and assistant program director to discuss resident issues. In
this format, the senior residents may discuss concerns they have
with the program or issues with junior residents. The program
director will address any concerns brought to him from other
Each fourth Friday of the month two residents present recent
publications as well as practice-changing papers. Attendings and
residents analyze the article for it's strengths and weaknesses.
This helps residents to think critically as well as developing
the habit of life-long learning and study. In addition this
activity assists them in preparing their own research for
Simulation and Certification
All residents are required to be certified in ACLS (Advanced
Cardiac Life Support) prior to beginning residency as well as
maintaining certification throughout residency. MedStar Union
Memorial Hospital provides ACLS courses free to residents for the
duration of their residency.
All categorical residents are required to be certified in ATLS
(Advanced Trauma Life Support) prior to beginning their third
year. This is done before the resident rotates at University of
Maryland's Shock Trauma Center and Johns Hopkins Hospital for the
acute care surgery rotation. The residency program will schedule
the course at Shock Trauma in time to start their trauma
All categorical residents undergo training for FLS (Fundamentals
of Laparoscopic Surgery) at our Clinical Simulation Lab. In
addition to regular practice on the FLS device, residents develop
significant laparoscopic skills during their residency in the
operating room with cases such as laparoscopic cholecystectomy,
colectomy, splenectomy, abdominoperineal resection, nephrectomy
and adrenalectomy. The exam is taken in their chief year so
residents will be FLS certified prior to taking the board exam.
Chief Resident Clinic
The two chief residents run an outpatient clinic for one-half day
a week, supervised by an attending physician. The clinic enables
continuity of care as the chief residents will see their patients
from the ED, patients admitted to hospital under their care or
patients on whom they performed surgery. They also see new
patients referred for surgical evaluation and schedule surgery
Clinical Simulation Center
These are offered on a monthly basis at the MedStar Clinical
Simulation Center near MedStar Harbor Hospital.
Interns (PGY 1)
- At the beginning of the year, courses such as Informed
Consent, Knot tying, Pig Feet Suturing, Effective Handovers, Bad
News Delivery and Top 10 Calls on the Floor provide orientation
for the new interns.
- For the remainder of the year, we simulate surgical problems
such as Post-Operative MI, Hematoma, Narcotic Overdose and
- They also learn procedures such as intubation, central line
placement and biopsy skills. Once they have been found to be
competent, they can perform these procedures when needed on
- In addition, Mega-Codes are done several times throughout the
year. This allows residents to practice ACLS skills in a
controlled environment as well as provides real-time feedback
from senior residents and attendings.
Junior Residents (PGY 2-3)
- Courses are offered in operative skills such as laparotomy,
carotid endarterectomy and open AAA repair.
- Time is set aside for residents to begin working on FLS
- As they improve in skills, junior residents will proctor and
teach the interns in procedural skills as well as Mega-Codes.
Senior Residents (PGY 4-5)
- Senior residents spend time perfecting their FLS skills in
preparation for taking the exam and becoming FLS certified.
- They also spend time proctoring and teaching interns and
- An laparoscopic simulator is available with advanced surgical
procedures such as lap hernia repair, lap cholecystectomy, lap
appendectomy, lap liver resections and lap colectomy.
Cadaver labs are scheduled with varying objectives grouped by
anatomic region (e.g. carotid dissection, tracheostomy, emergent
cricothyroidotomy, accessory nerve and recurrent laryngeal nerve
dissection, thyroid and parathyroid dissection in head and neck).
With each session, senior residents teach junior residents
dissection and surgical skills in a situation where the
consequences of a mistake are not what they would be on a living
patient. Attendings supervise the learning session and assist in
helping meet the goals and objectives.
A mock oral examination is scheduled twice a year. All categorical residents take the mock oral exam where they are placed in three different rooms with attendings in each room. Exam questions are structured around core surgical knowledge and allows the residents to practice logical thinking as well as planning safe surgical management of patients.