First Year (PGY-1)
The intern year provides incoming residents with a solid introduction to the breadth and diversity of surgery. The requirement, as outlined below, can be fulfilled at the base hospitals, UPMC Jameson and UPMC Horizon, with the following exceptions: three months of out-of-house rotations in the ICU/CCU at UPMC Presbyterian, Burn/General Surgery at UPMC Mercy, as well as pediatric surgery at UPMC Children's Hospital of Pittsburgh. Rotations typically involve possibly one or two other senior residents, along with an attending physician and possibly a medical student. This allows our residents to receive one-on-one ratio training.
UPMC Horizon provides PGY 1 resident Central Venous Catheter Placement Training and Certification by attending the Peter M. Winter Institute for Simulation, Education & Research (“WISER” Institute) located in Pittsburgh which is the comprehensive, technologically advanced simulation lab for all University of Pittsburgh Medical Center trainees. All residents are required to complete and maintain ATLS, BLS and ACLS certifications throughout residency. BLS and ACLS are provided at UPMC Horizon and UPMC Jameson’s Education Departments. ATLS courses are provided through UPMC according to the standards established by the American College of Surgeons Committee on Trauma and this course is usually held at UPMC Presbyterian Shadyside Hospital. Residents have access to a patient simulator (“Sim Man”) located in the Education Department at UPMC Horizon’s Greenville Campus.
By the end of first year, residents must demonstrate procedural competences in central venous access placement, arterial catheterization, insertion of pleural and other pigtail catheters, insertion of chest tubes, endotracheal intubations, cystoscopy, EGD, colonoscopy, bronchoscopy.
A resident’s call schedule typically includes one weekend day and/or night and one month of night float.
Second Year (PGY-2)
PGY-2 residents who demonstrate good performance may be given responsibility for independent judgment and surgical decision-making with continued attending supervision. The PGY2 resident is responsible for day-to-day care of surgical patients on their assigned service and patients they follow as consultants. They will be supervised at all times by senior residents and faculty. The major goal of the second year of residency is to allow graded responsibility for patient care, including instruction in pre- and postoperative care, and the evaluation and management of patients seen in consultation. The PGY-2 will gain additional valuable experience in the operating room both as an assistant and as the primary surgeon on uncomplicated surgeries.
PGY-2 residents rotate for four weeks within the transplant intensive care unit (TICU) at the University of Pittsburgh Medical Center Montefiore hospital which is part of UPMC General Surgery Presbyterian Shadyside. The residents will have a robust exposure to transplantation of abdominal organ patients.
A resident's call schedule continues to be 1-2 weekend days per month (call from home). This schedule may vary month-to-month, depending on the out-of-house rotation schedule and vacations.
Third Year (PGY-3)
By the third year, residents may be given more responsibility for evaluating surgical patients in the emergency room, initiating preoperative treatment and arranging for further surgical care. In addition, PGY 3 residents are more involved with the technical aspects of the surgery in the operating room. The goal for the PGY-3 residents is to expose them to some of the more complex aspects of clinical surgery and to develop the clinical judgment necessary to decide who needs an operation, what operation, and the appropriate timing. PGY-3 residents are expected to master basic surgical techniques as well as more advanced techniques including laparoscopic skills, burn management and completion of FES and FLS examinations no later than the end of the PGY-3 year. Leadership and supervisory skills are further developed.
Fourth (PGY-4) and Fifth Year (PGY-5)
The last two years of clinical training are designed to provide residents with an extensive operative experience. The PG-4 and PG-5 residents are the team leaders (chief residents) and under the supervision of the faculty they supervise junior residents and make decisions about patient care. They perform complex operations under the supervision of the faculty. These senior residents are expected to exercise increasing degrees of independent responsibility for surgical decision-making and perform more advanced surgical procedures, while attending surgeons monitor their progress and continue to supervise the service. Senior residents are allowed and encouraged to exercise independent surgical judgment to the degree that is consistent with good patient care. The goal of these two years is to transition the individual from a resident to an independently practicing surgeon.
Comprehensive Longitudinal Experiences
The second- through fifth-year curriculum offers more surgery rotations, along with the required rotations by the ACGME, in order to achieve a greater educational experience in general surgery.
Monthly Journal Club
Monthly general surgery journal club requires the residents to locate, appraise, and assimilate evidence from scientific studies as it applies to patient medical and surgical problems. Residents are assigned articles to review, dissect, and present to the residency program. This resident driven education with faculty leadership oversight is an integral part the evidence-based care process. Chief residents are required to review updated literature with the aid of the online UPMC Health Sciences Library System (HSLS) to select the most appropriate articles for resident review. There is a required faculty presence during resident discussion of these topics to provide further experience-based insight into surgical topics and to guide discussion.
Weekly General Surgery protected education/conference
The program structures the curriculum to provide constant dedicated and protected time weekly to learn and master the curriculum. This four hour dedicated educational block allows the resident to heighten their knowledge base in general surgery with constant oversight through the curriculum. The faculty provides the education and oversight weekly to ensure successful completion of the published curriculum. The grand rounds are offered monthly via an online webinar.
Weekly Multidisciplinary Cancer Conference
Cancer Conference is an excellent opportunity for residents to actively participate in interdisciplinary care. Residents present the patient case for discussion describing all pertinent surgical information. Then, pathology, radiology, radiation oncology and hematology/oncology all participate discussing their assessments and proposed treatment opinions. This allows to observe, in real time, how the multidisciplinary care plan will function for their patient.
Laparoscopic training modules
Two Fundamentals of Laparoscopic Surgery (FLS) trainers are available to all residents at the primary clinical sites (UPMC Jameson and UPMC Horizon) and residents log approximately six hours per month in training/practice skills. The residents follow the FLS trainer curriculum from PGY 1 – PGY 5 established by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) which includes both didactic curriculum and hands-on training. The hands-on skills lab aims to develop basic and advanced laparoscopic and special skills which are then transferrable to the operating room during laparoscopic cases
Quarterly Surgical Morbidity and Mortality Conference
General surgery residents present cases during our department of surgery morbidity and mortality (M & M) conferences. The residents are intimately involved with the care of patients from multiple surgical disciplines other than general surgery. They are responsible for detailed presentations and the application of current scientific data obtained from literature research to patient care as it pertains to the M & M conference. They are accepting and giving constructive criticism regarding their patient care and applications of evidence-based/best practice medicine. The committee includes professionals involved in patient safety, quality improvement, and risk management.
Continuity Training Experience for General Surgery
The continuity training experience, within the continuity of care surgical clinic, provides the resident with a training environment equivalent to that of a private practice. The continuity of care clinic is conducted by several surgical physicians who have a lifetime of experience to share with each resident.
Residents spend one half-day per week in the surgical clinic during their PGY-1 and two half-days per month PGY-2 through PGY-5 training years. In the outpatient clinical setting the residents are directly exposed to socioeconomic and cultural diversity among the patient population. The resident becomes familiar with the differing cultural and family dynamics that affect surgical healthcare delivery and how to deal with each scenario. During their pre-operative evaluation, the surgical resident will gain experiential learning in developing both non-operative and operative plans. During the post-operative care of the patient, the resident will be responsible for medication adjustments, pain management, wound/incision care, drain management, scheduling follow up appointments/care, and order any pertinent lab/radiographic studies.