Educational Expectations and Goals for Each Post Graduate Year
Responsibilities and Rotations
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 .
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
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 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.
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
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 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.
Library of computer based CD instruction on various minimal access procedures.
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.
Introduction to instruments & video (1.5 hours)
Access and Camera navigation
Laparoscopic common bile duct exploration
Laparoscopic hernia repair
Laparoscopic suturing and tying
Laparoscopic feeding tubes/ bowel resection
Laparoscopic management of GERD
Laparoscopic nephrectomy/ solid organ
Laparoscopic bariatric surgery.