Overview

As medicine - and surgery - traverse a time of particularly noticeable change, it is worthwhile to focus upon the nature of surgical training. It is a nearly unique undertaking combining the acquisition of an enormous body of cognitive knowledge encompassing the clinical and basic sciences of surgery, the development of technical skills comparable to those of an artist (and of the "hottest" video gamer) and, above all, the mastery of clinical judgment.

A fundamental education principle of any general surgery program is to adequately prepare the resident for Board Certification. Simply "Passing the Boards" is not sufficient, however; the goal of the SUNY Upstate Program is to provide you with the best possible education and training for a career in General Surgery or one of its disciplines. To derive the maximal benefit from your residency requires that you actively participate in every aspect of the program, from the operating room to the classroom. Self-instruction and motivation are the primary principles of adult education. The clearly established objective of this residency program is to prepare the participants to be safe and effective surgeons and to enable them to embark on a successful and satisfying career in their chosen field of surgery.

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.

But the "times, they are a changing" when it comes to clinical education. 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.

First year surgical residents, (PG-1) are admitted to the training program through the National Resident Matching Program (NRMP). Five categorical first year positions in general surgery are available each July 1st. In addition, approximately eleven designated and as many as seven undesignated preliminary first year positions are available each year. Preliminary slots are available for one or two years, depending upon the individual resident's specialty requirements.

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 patient care, medical knowledge, evidence of practice-based learning and improvement, interpersonal and communication skills, professionalism, and the surgical resident's demonstrated awareness of the system-based practice of medicine. 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.

For More Information

Rose Thomas, Residency Coordinator
SUNY Upstate Medical University
750 E. Adams Street
Syracuse, New York 13210
VOICE:(315) 464-6289
E-mail: thomasr@upstate.edu