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Academic Experience - General Surgery at MedStar Union Memorial

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 options.

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 PGY level.
  • Also for two out of four weeks, residents present material and answer the questions assigned for that week in the SCORE curriculum.
  • 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.


Conferences

Tumor Board

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?

Chief Conference

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 departments.

Journal Club

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 publication.


Simulation and Certification

ACLS

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.

ATLS

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 rotation.

FLS

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 when needed.

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 Tension Pneumothorax.
  • 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 patients.
  • 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 competency.
  • 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 junior residents.
  • 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 Lab

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.

Mock Orals

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.