Since surgery is a "hands-on" specialty and requires exposure to a variety of patient problems and pathologies, residency training in surgery is primarily an exercise in direct patient contact. Historically, clinical education has been provided in the format of a combination of mentorship and work experience. It had been thought that an immersion into the clinical setting as a "house officer" was the best form of clinical education. Unfortunately, in a number of institutions throughout the country, this has deteriorated into a form of involuntary servitude which extracted a tremendous amount of work out of the young doctors without much of an educational experience in return.
There is no question that exposure to a broad variety of clinical conditions and operations will be the main focus of your education while in the residency, but as surgical educators, we can no longer rely on "random opportunity" to define your surgical curriculum. We must control and enhance the educational value of the rotations to which you will be assigned. The faculty, therefore, will attempt to bolster the educational experience of the rotations through informal teaching sessions, rounds, and special attention to learning opportunities presented by their patients.
The Department of Surgery at SUNY Upstate Medical University offers a traditional, comprehensive, fully ACGME accredited general surgery residency program with a curriculum emphasizing supervised experience in both traditional, open surgical procedures and newer, laparoscopic, minimally invasive and robotic techniques. Elective opportunities for basic and clinical research are also available as part of the residency program. University Hospital, a 409-bed, Level I Trauma Center, and Golisano Childrens Hospital serve 17 counties in the Upstate and Central New York area. Resident teams also rotate through the general surgery teaching services at adjacent Crouse Hospital, nearby Veterans Administration Hospital, St. Josephs Hospital Health Center and Upstate University Hospital at Community General.
Clinical duties are performed at not only University Hospital but also several community hospitals and the Syracuse Veteran's Affairs Hospital. This broad exposure to different health-care delivery models provides a balanced and complete educational experience, but also offers interaction and training from a wide variety of surgeons in all types of practice.
University Hospital: A 400+ bed, Level I Trauma Center that serves 17 counties in upstate and central New York, this hospital has recently expanded with the addition of the Golisano Children's Hospital and north towers which opened in 2009. Operating room capabilities include 19 operating rooms (adult and pediatric). Surgical services rotated on include General Surgery, Trauma Surgery, Acute Care Surgery, Transplant Surgery, Thoracic Surgery, Vascular Surgery, Pediatric Surgery, SICU, Bariatric Surgery, Advanced Laparoscopic and Hepatobiliary Surgery. Elective surgical rotations include Orthopedic Surgery, Neurosurgery, Urology and ENT.
Crouse Hospital: A 570+ bed community hospital physically connected to University Hospital, this hospital provides a wide range of surgical services and includes a 50 bed neonatal intensive care unit. Construction on new operating rooms is currently underway. Surgical services covered include General Surgery, Thoracic Surgery, Vascular Surgery, and Pediatric Surgery.
Syracuse Veteran's Affairs (VA) Hospital: A full-service Veteran's hospital, this facility provides surgical rotations encompassing general, vascular, and thoracic trauma in a unique patient population.
St. Joseph's (St. Joe's) Hospital: A community hospital with centers of excellence in vascular surgery and cardiac health, this private hospital, located about 2 miles from University Hospital provides rotations in vascular surgery and colorectal surgery. The vascular rotation is particularly busy with 5 surgeons and some of the highest numbers of carotid endarterectomies and peripheral bypasses in upstate New York.
Community Campus: Rotations at this hospital provide exposure to a busy general surgery service covering many of the "bread and butter" general surgery cases in Syracuse.
The Accreditation Council in Graduate Medical Education (ACGME) specifies in considerable detail what clinical experiences must be included in a general surgery residency program; the rotations in the five clinical years of our residency program conform to that "blueprint."
During the first two years of training, about half of the rotations are devoted to general surgery and its principal components (e.g. trauma, vascular surgery, etc.) with experience in surgical specialties and other (e.g. Critical Care) specialties constituting the remaining half.
In the third, fourth and fifth years, about two-thirds of the time is spent on general surgical services; the other rotations include components of general surgery, such as transplant, pediatric and vascular surgery.
Residents are assigned progressive responsibility for patient care by the supervising attending physician and the surgery Program Director/Chair based on faculty evaluations of clinical competence, including:
Promotion and assignment to progressive patient care responsibilities requires satisfactory completion of the training objectives specific for each PGY year as assessed by the faculty. Operative experience under supervision is provided and stressed at all levels of the residency. The resident progressively acquires more extensive knowledge of surgical physiology, develops technical skills and gains a thorough understanding of the aims, attitudes and philosophies of surgery. As a PGY-5, each chief resident, while working along side of the attending surgeons, is in charge of his/her own service, exercising major independent responsibility.
The rotations for the categorical residents, while slightly different from resident to resident, provide an equivalent experience during each year of training.
For the preliminary residents in orthopedics, ENT, neurosurgery and urology, the rotations have been tailored to fit within the requirements established by the specialty boards governing those training programs. For the most part, the rotations for the non-designated preliminaries are similar to the categorical general surgery residents unless specific requirements are necessary for continued training in different specialties (i.e. radiology or anesthesiology).
It is not difficult to imagine the challenges dominating five or more years of clinical training. But they need not, should not, be all-consuming. Friends and family, rest and recreation, enjoyment of the arts and service to the community are no less important because you are a resident. Indeed, during this portion of your career when time is perhaps your most precious commodity, it is vital that you strike a balance in your life that allows you to progress toward personal, as well as, professional goals.
Operative experience under supervision is provided and stressed at all levels of the residency. The resident progressively acquires more extensive knowledge of surgical physiology, develops technical skills, and gains a thorough understanding of the aims, attitudes, and philosophies of surgery.