Revised 10/13/2024
GENERAL SURGERY RESIDENCY PROGRAM
Program Structure
In the PGY1 year, care of the surgical patient, proper workup of common elective and emergency patient presentations, proper workup of stable trauma patients, and a strong foundational understanding of the natural history of surgical disease is taught. Categorical interns also spend 1 month on the GI service, and one month in which the morning is spent on the anesthesia or IR services. In the PGY2 year this progresses to postoperative care of the critically ill surgical patient, proper workup of less common elective and emergency patient presentations, proper treatment of patients in shock, and proper workup of unstable trauma patients. Our PGY2 residents spend significant time in the surgical ICU. PGY3 residents start taking overnight call as the senior resident at SJGH and learn to apply the skills and knowledge learned in the previous two years to acute presentations of surgical and trauma patients in the emergency department and start to teach bedside procedures and proper care of floor patients to the interns. During PGY 3 year, residents spend time on specialty rotations at UC Davis and Stanford, where they are involved in transplant surgery, surgical oncology, and pediatric surgery. PGY4 residents begin to function as a full chief resident on a service. An emphasis is placed on leadership and ownership of patients as well as executive function and surgical skills. They learn how to teach a variety of learners in and out of the operating room, how to run a trauma floor and intake service efficiently and safely, how to manage the many interests competing for their time, develop leadership skills, and become didactic teachers at our weekly conferences. A significant portion of the PGY-4 year is spent running the Acute Care Surgery and Trauma Surgery Services as chief.
By the beginning of PGY-5 year, there is an expectation that you know how to operate and manage patients effectively. The PGY-5 residents are expected to function as junior attendings and program sub-faculty. There is significant responsibility for the function of the service and care of patients. Significant attention is directed towards ensuring that residents are ready for advancement to the chief level. This is a key distinction of this program. We want to graduate real surgeons, who have experienced real-world practice prior to finishing training. There is a strong emphasis on becoming a professional surgeon, both in terms of language, behavior, knowledge base, leadership skills and teaching ability. The PGY-5 residents have unmatched authority in treatment of patients and function of their team. However, the expectations for them are also very high. There is also a strong emphasis on learning to present their care plans to colleagues, a skillset necessary for oral boards and in daily practice. Our didactic curriculum consists of 36 disease- and system-based months. The four week blocks consist of lectures from both senior residents and attendings to establish foundational anatomy, physiology, and pathophysiology, as well as skills sessions to teach or simulate new procedural and cognitive skills. Sabiston’s Textbook of Surgery and various online resources supplement these sessions. We also use the SCORE curriculum. For our more senior residents we provide mock oral board scenarios through out the year.
As ours is a community residency program, residents are expected to develop true operative independence and be capable general surgeons upon graduation. Our residents typically have one thousand major cases at the beginning of their chief year, and typically graduate with almost 1500 major cases. Our interns are expected to master the large majority of bedside procedures – ultrasound-guided central venous access, abscess incision and drainage, Foley and nasogastric catheter placement, intubation, bedside management and debridement of wounds, percutaneous and surgical chest tube placement, proper use of negative pressure wound therapy, upper and lower endoscopy, etc. – in their first six months and spend the second half of the academic year teaching some of these skills to promising medical students. PGY2s are expected to master the remaining bedside procedures – percutaneous tracheostomy, peripheral arterial access, bronchoscopy, suprapubic bladder catheterization, etc. – during their SICU rotation. In the PGY1 and 2 years our residents scrub into far more than the ACGME-required 250 cases, and in the latter half of the year the attending will often observe these cases un-scrubbed while the senior and junior residents operate together. The PGY3 year is spent participating in the some of the more specialized areas of general surgery such as pediatric surgery, surgical oncology, and hepatopancreaticobiliary surgery at UC Davis or Stanford, and beginning to operate independently on simpler general surgery cases while at SJGH and SJMC. Finally, in the PGY4 and 5 years the residents are typically in the operating room after morning rounds, managing their services from the operating room, and leading fellowship-level operations with attendings or taking junior residents through simpler general surgery cases with the attending available but in the background. Since there are no fellows at SJGH or SJMC there are no barriers between the resident and attending at these institutions, even in the most advanced cases.
All rotations are four weeks long, with 13 rotations per year. The year begins on July 1 and ends on June 30. UCD is in Sacramento, 55 miles north of SJGH, and residents are housed in an apartment across the street from the hospital while rotating there at the program’s expense. Stanford Medical Center is in Palo Alto, 75 miles west of SJGH, and residents are housed in the Bay Area while rotating there.
While at Washington Hospital, in Fremont, residents are housed near the hospital and work with the general surgeons for inpatient and outpatient surgery experience.
This year’s typical, approximate, resident schedule is organized as follows:
PGY1 (all rotations at SJGH)
PGY2 (rotations at SJGH and SJMC)
PGY3 (rotations at SJGH, SJMC, and UCD)
PGY4 (rotations at SJGH, SJMC, and an elective at any accepting institution)
PGY5 (rotations at SJGH and SJMC)