Physicians Residency
Surgery

Dr. Raleigh Kent

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The Educational Program in Surgery at Physicians Medical Center Carraway (PMCC) combines the strengths of an academic medical center with the practical advantages of a community hospital. The surgical resident reaps the rewards of an intense surgical experience, weighted toward early operative skill development and guided by close faculty level supervision. This philosophy permeates the residency program and leads to close interactions among residents as well as between residents and faculty.

The early emphasis on operative skill development is carried forward in the context of an intellectual continuum, beginning with the preoperative assessment of the patient and following through to the patient's postoperative and convalescent care. Believing the dictum that a resident learns more by managing the patient upon whom he/she operates, pre and postoperative care are emphasized early in the educational program. Each resident develops keen awareness and expertise in recognition of preoperative risk factors and care of postoperative complications. Responsibility in the operating room requires preparation and dexterity, and the level of operative complexity depends on the individual. The program is non-pyramidal; it is the intention to finish all who are accepted and strive to achieve excellence.

Goal
The Educational Program in Surgery has one purpose: to prepare the resident to become a superior clinical surgeon. The means to attain this goal are multifaceted. Success is customarily measured by performance on the qualifying and certifying examinations of the American Board of Surgery, but emphasis is also placed on the humanistic side of surgery and the intangible concept of surgical judgment. The descriptions of the Educational Program in Surgery which follow serve to underscore the breadth of exposure the surgical resident has to the technical, didactic and scholarly aspects of surgery.

Graded Responsibility
The initial years of the surgical residency emphasize preoperative and postoperative care and mastery of operative skills, in order to prepare for a career in general surgery or a surgical specialty. Developing empathy for surgical patients and their families and determining operative risk and benefit are stressed. Each resident receives extensive operative experience as first assistant and by performing, under supervision, a variety of surgical procedures commensurate with his or her level of ability.

During the first two years, the resident gains experience in the broad field of general surgery, as well as vascular surgery, emergency medicine, plastic surgery, neurosurgery and anesthesia. Additional elective rotations are available in orthopedics, urology, and otolaryngology.

Off-site rotations include transplantation and pediatric surgery. Nonetheless, the resident is fortunate to spend most of his/her residency at PMCC under the watchful eye of full time surgical faculty.

Those continuing in the general surgery program receive progressive responsibility leading to the opportunity to independently manage complex surgical problems and prioritize care of the critically ill. The resident is challenged at all times to make and justify decisions which affect the patient's care and outcome. Junior residents participate in overall care of patients suffering from both acute and chronic surgical illness. Endoscopic experience in the GI clinic vastly exceeds the minimum required caseload. The fourth year is a concentrated clinical year and includes experience as Senior Resident on the trauma service at DCH Medical Center, one of Alabama's busiest emergency facilities, as well as continued exposure to vascular and general surgery. The fifth and final year is spent as Chief Resident on the two general surgical services and on the vascular service.

Conferences
The conference schedule is an active one, which balances the need for didactic education with the demands of a busy clinical schedule. Resident attendance is expected at the following weekly sessions:

> Multidisciplinary Resident Conference
> Basic Science Conference
> Mortality & Morbidity Conference
> Surgical Textbook review

The Multidisciplinary Resident Conference addresses curriculum issues common to residents in all disciplines, and, in rotation, a Cancer Conference that includes all specialties which deal with the diagnosis and treatment of malignancies. The surgical resident learns from discussions by both surgical and non-surgical faculty. The Basic Science Conference is resident-led, and presentations originate from a defined list of topics covering the entire spectrum of basic science as it relates to surgical care. The Mortality & Morbidity Conference involves presentations by the operating surgical resident who describes events leading to a complication or death; discussion is led by surgical faculty. This conference is the backbone of the teaching program and follows the supposition that it is best to learn from adverse experience of others.

Additional learning experiences include Textbook Review and Journal Club. The textbook review program provides each resident with one of the authoritative surgical textbooks, which is purchased by the Program, and assigns chapter readings each week. A weekly written quiz is given to confirm resident reading. A prize is awarded each year for the best scores on the textbook review. This emphasis on core surgical knowledge is complemented by a monthly Journal Club which has its emphasis on the surgical literature. Journal Club is an educational experience and also an opportunity to interact socially with colleagues. Articles are assigned from contemporary literature and presented over dinner at local restaurants. Faculty members provide insightful comments.

Meetings and Vacations
To further the educational value of the residency years, each resident in the senior program is provided a stipend to attend a scientific surgical conference. The meeting may be selected by the resident, subject to the approval of the program director. In addition, residents are encouraged to submit abstracts for presentation and, if accepted, their meeting expenses are covered by the program.

Total vacation time approaches three weeks, with two weeks traditional vacation and an additional week allocated during the Holiday Season.

Research
Residents who participate in meritorious research gain greatly in knowledge, clinical insight and self-confidence. Although program emphasis is on clinical surgery, each resident is expected to engage in a meaningful research activity. Presentations are encouraged at the annual Physicians Education and Research Day, a forum which provides an opportunity to showcase research activities at PMCC and offers awards for best papers. Residents are encouraged to participate with faculty in pursuing clinical studies. Presentations and publications in collaboration with faculty constitute the mainstay of scholarly activity within the program, and both basic science and clinical research are available.

Surgeons as Physicians First
Through curriculum innovation and new approaches to learning, the program strengthens the role of the surgeon as a compassionate and caring physician. Enhancement of communication skills, participation in hospital performance improvement programs, and an emphasis on the role of colleagues and cost sensitive patient care are stressed throughout the program. Upon completion of the program, the resident will be qualified to take his/her place among other practitioners and interact in a collegial and effective manner.

Evaluation
Residents are evaluated at the completion of each clinical rotation. These evaluations are available for review by the resident and are discussed periodically by faculty at meetings of the Surgery Program Advisory Committee. The resident is expected to prepare for and take the American Board of Surgery In-Training Examination(ABSITE). Semi-annual meetings occur between the individual resident and the Program Director, in order to review resident performance and provide constructive recommendations. Such meetings may occur more frequently if remediation is necessary. It is the intent of the program to finish all residents who are accepted into categorical positions, provided the resident's performance warrants such support. The faculty is also annually evaluated by residents, and these evaluations are reviewed with individual faculty members by the program director in order to stimulate teaching excellence among faculty.

Faculty
A residency program is only as good as its faculty and the quality of the residents it attracts. Physicians is fortunate in having an excellent geographically based full time teaching staff dedicated to the surgical residency program. Each faculty member is skilled in general surgery and complements his general surgery expertise with an area of special interest. Current areas of special interest include vascular surgery, non-cardiac thoracic surgery, minimally invasive surgery, trauma/surgical critical care, complicated wound management, bariatric surgery, colon and rectal surgery, breast disease management, and endocrine surgery. In addition, surgical specialists are geographically full time in urology, neurosurgery, orthopedic surgery, plastic surgery, otolaryngology, ophthalmology, cardiac surgery and anesthesia. Since there are no specialty residents, experience in the surgical specialties is more meaningful and the operative experience is excellent.

Defined Category Report

Resident Recruitment
Physicians Medical Center Carraway participates in the National Resident Matching Program (NRMP). The surgical residency is five years in duration, and three PG-1 categorical positions are offered. It is expected that these three individuals will continue through the five years of the program. Additional positions are offered to resident applicants who want one or two years of surgical training prior to entering a related field. The Educational Program in Surgery welcomes inquiries from qualified applicants.

Physicians Medical Center Carraway
Surgical Residency Program
1600 Carraway Boulevard
Birmingham, Alabama 35234
(205) 502-6230
gsres@pmcc.net