Educational Expectations and Goals for Each Post Graduate Year

Responsibilities and Rotations

PGY1
PGY-1 residents are responsible for documenting the initial history and physical examination, and for the basic pre- and post-operative care of patients under the supervision of senior residents and attending staff. The PGY-1 acquires psychomotor and technical proficiency commensurate with his or her skills, while performing procedures at the bedside and in the Emergency Department under the direct supervision of attending physicians or the more senior resident staff. In the operating room the resident works under the supervision of the attending staff. Rotations include general, vascular, ICU, cardiothoracic, and orthopedic surgery .

PGY-2
At the PGY-2 level, resident responsibilities are increased to provide for growth in obtaining and interpreting pertinent data and making important decisions regarding patient care. Technical experience in the operating room continues to accelerate under the supervision of the attending staff. Rotations include tours on the consult service, general surgery teams, cardiac surgery, and the surgical critical care units.

PGY-3
The PGY-3 resident becomes the middle-level resident of the surgical team. The year includes pediatric surgery, as well as rotations to allow improved skills in managing consultations and rotations as the senior resident in the surgical intensive care unit. Emphasis remains on the continued development of surgical skill and greater responsibility for surgical judgment and decisions necessary for patient management, both pre- and post-operatively.

PGY-4
PGY-4 residents become senior assistant residents on the surgical teams and begin to acquire the organizational and interpersonal skills to be the senior member of a clinical service. At this level, residents assume greater responsibility for teaching junior resident and medical students. One's operative experience continues to increase in number and complexity of cases.

PGY-5
The chief resident year carries major operative experience and teaching responsibilities as the team leader in general and vascular surgery. The PGY-5 resident has senior management responsibility for patients in consultation with the attending staff. The chief residents create and manage the year-long and monthly rotation schedules, and schedule vacations. They also coordinate the journal club and grand rounds speaker schedule. During this time, the resident also is exposed to the most technically challenging surgical cases. On completing this year, residents will be experienced clinical surgeons, who have developed good judgment and compassion for their patients. They will have learned to read the literature critically, express concepts clearly in conferences, and will be prepared for a lifetime career and a leadership role in surgery.

Research Fellow:

An opportunity exists for residents to pursue laboratory and clinical investigation. During the research year, residents learn the basic tenets of scientific investigation. The year is designed around a resident's interests and future professional goals.

Residents have opportunities to pursue basic science, animal studies and clinical projects. Many areas of research are currently available in a broad range of disciplines. A close relationship exists with Columbia University and the many undergraduate and graduate departments, most notably, Computer science, Machine Learning, and Biomedical Engineering. One has the ability to continue current studies or develop new ones during the research year. To learn more about current and past academic research please visit the Surgical Sciences Laboratory.

Cumulative Operative Experience

During the five-year training program, residents will perform between 750 and 900 cases under the supervision of the attending surgical staff and chief residents. Approximately 200 to 250 will be performed during the chief year. Graduating residents meet all the core requirements in scope and number of procedures and categories.

Medical Libraries

Medical libraries are located at both divisions. The libraries, which are open seven days a week, provide access to an extensive collection of medical journals and texts. Residents also can take advantage of all of the facilities of Columbia University , including the Health Sciences Center Library. This library possesses one of the world's most extensive collections of medical and research documents.

The Department has also invested in providing a separate Surgical Resident's Library at the Roosevelt Hospital . This area is equipped with the most recent versions of all major surgical and medical texts and is updated with the latest issues of the major surgical subscriptions. The library is located in an ideal situation for easy accessibility for all surgical residents 24 hours a day, 7 days a week.

Technology in Residency Training

The Department of Surgery is actively involved in the advancement and incorporation of technology in the training of future surgeons in the residency program. All categorical residents are provided the newest Palm(TM) handheld computers for sharing patient lists and recording and registering all operative and non-operative cases for the ACGME. Additionally, the Department has invested in updating the computing resources available in the residency lounges to include full multimedia resources for scanning, presentations, and digital editing. New computer resources for on-line training (including SESAP) have been installed and more are sure to come. A new multimedia center has also been installed for review of instructional videos and presentations during conferences and rounds and resident's spare time. The department employs a computer scientist to assist in technology and research initiatives.

MINIMAL ACCESS SURGERY TRAINING PROGRAM

Training Facilities and Curriculum

Surgical training is rapidly undergoing change. Limited resident work hours, economic pressures, and patient safety concerns have affected the surgeon-in-training's ability to efficiently acquire surgical skills. Additionally, the advent of minimally invasive surgery has pushed the need for psychomotor skills training. Compared with traditional "open" surgery, the minimal access technique requires operating in a 3D field with 2D visualization, longer instruments, muted tactile feedback , and the "fulcrum effect," whereby the instruments and scopes are limited in movement by the fixation point of the abdominal wall.

In the Center's Simulation, Training and Robotic Surgery Simulation Lab, surgeons and residents gain proficiency in basic and advanced laparoscopic procedures and robotic techniques. The Center provides surgical residents with innovative training in a new and comprehensive educational and research facility for minimal access and robotic surgery. Residents will participate in regularly scheduled animate labs to learn on live tissue. Inanimate training video towers are available 24 hours per day for resident use. Virtual reality simulators, similar to those used in aviation, complements training and provides research opportunities to prepare the next generation of minimally invasive surgeons. Training in minimally invasive skills with a virtual reality simulator allows residents to practice repeatedly with immediate feedback and gain familiarity with anatomy and instrument utilization in a safe and reproducible environment. The department of surgery is actively participating in research exploring the impact of this minimally invasive surgery on patient care and surgeon training. The curriculum developed for our residents provides them with skills and exposure to technology to prepare them for the challenges of the 21st century.

Computer didactics

Library of computer based CD instruction on various minimal access procedures.

Inanimate Training

Four "box" trainer with instruments, and full video towers. Each exercise will be timed, and evaluated for errors.

Virtual reality simulation training using the LapSim.

Animate training

Introduction to instruments & video (1.5 hours)

Access and Camera navigation

Laparoscopic Appendectomy

Laparoscopic Cholecystectomy

Laparoscopic common bile duct exploration

Endoscopy

Laparoscopic hernia repair

Laparoscopic suturing and tying

Laparoscopic feeding tubes/ bowel resection

Laparoscopic management of GERD

Laparoscopic nephrectomy/ solid organ

Laparoscopic colectomy

Laparoscopic bariatric surgery.

Robotics