Tissue Lab Training for Residents at the Center for Surgical Innovation with Dr. Paul Montero, Director of Simulation
Clinical experiences at the five-year University of Colorado Residency Program in General Surgery cover the full range of surgical services, provide exposure to a wide variety of surgical subspecialties, and allow for residents to participate in upper and lower endoscopy, critical care, Level I Trauma care, burn and transplant care. The sites within the residency program allow for exposure to diverse patient populations within the academic health center, a Veteran’s Administration Medical Center, Denver Health, a busy Metro Denver Level I Medical Center, and Memorial Hospital in Colorado Springs, a busy hospital with high case volume in general surgery, as well as a premiere Children's Hospital, which resides on the same campus as the academic health center.
Our surgical residents are challenged to be compassionate, technically competent surgeons and are given opportunities in the arenas of patient care, teaching and research. Most categorical residents have spent two years in the research laboratory or doing academic graduate work and beginning in 2017-18 this academic/research time will be expected of all categorical residents. We also provide a fourth-year elective, which many residents have chosen to spend overseas or regionally at a center of excellence in their chosen field. There will be 10 categorical intern positions and 18 PGY-1 preliminary positions offered in 2017-18.
Residents training at the Center for Surgical Innovation
The objectives of the surgical internship are to achieve a wide experience in the broad field of surgery, including preoperative evaluation and post operative care of all classes of surgical patients and to begin the development of technical surgical skills. The essentials of preoperative and postoperative care include the recognition and treatment of surgical complications, fluid and electrolyte balance, wound care, and nutritional support. The intern rotates through 1 block (1 block = 28 days) of pediatric surgery, 1 block of oncologic surgery, 2 blocks of VA hospital in general and vascular surgery, 1 block of critical care/Cardiothoracic Surgery, 1 block of university hospital night float plus trauma, plastic/reconstructive surgery, hepatobiliary surgery,thoracic surgery, vascular surgery, acute care surgery Memorial Hospital general surgery with robotic exposure, and minimally invasive surgery. The intern does supervised surgical procedures, gains expertise in vascular access, and other invasive procedures; e.g., tube thoracostomy, FAST examinations, etc. The intern does admission work-ups, writes pre and postoperative orders, progress notes and hospital discharge summaries. The schedule for the interns and junior residents is templated to facilitate compliance with duty hours requirements and also provide maximal educational exposure using several float services. See a sample schedule.
In the Operating Room. Photo from Karen Lo, MD
During the second year of training the emphasis is primarily on perfecting motor skills and the management of more seriously ill patients. There are rotations on surgical intensive care, burn, trauma, general, oncology, vascular, and cardiothoracic critical care, with exposure to a wide variety of seriously ill patients. The resident learns the ability to coordinate the daily work of busy services, evaluating surgical consultations, and assessing priorities in patient care. During intensive care rotations, the resident learns invasive monitoring, ventilator management and the critical care management of patients from all surgical disciplines as well as performing all invasive procedures such as central line placement, tube thoracostomy, bronchoscopy, percutaneous endoscopic gastrostomy and tracheostomy. At the end of this year the resident should be able to provide non-operative care to all classes of surgical patients regardless of the magnitude of illness or injury.
In the third year, the resident is frequently the second most senior resident on services at the University of Colorado Hospital, Denver Health Medical Center, VA Hospital, and Children's Hospital. At these institutions the resident is exposed to a wide variety of elective and emergent surgical cases in general surgery, pediatric surgery vascular surgery, transplantation, oncology, trauma, and endoscopy. Residents will also do a block rotation on breast as the primary resident. In addition, the resident is usually the consult person for these rotations. Gaining technical competence and breadth is a major objective of this year.
Doug Overbey, MD, PGY-4, Simulation Training for Vascular Procedures
The goals for the fourth year of surgical training are to refine the resident’s capabilities in independent surgical decision making, advanced surgical technique, and leadership. To accomplish this, residents rotate on services where they are usually the senior most resident on the service. Rotations include: Thoracic and Vascular surgery at Memorial Hospital; Trauma/general surgery at Denver Health Medical Center; General surgery, Acute Care Surgery, Thoracic Surgery, and Vascular Surgery at University of Colorado Hospital, and Thoracic Surgery at VAMC as well as a high-volume bread and butter surgical rotation at Memorial Hospital in Colorado Springs. The Department of Surgery sponsors a one-block elective which the resident can take within an accredited surgical residency program in the US or an international elective site approved for them individually by the Surgery RRC and the American Board of Surgery in accordance with their nternational rotation guidelines.
Daine Bennett, recent Chief resident, meets with the clinical team
The goals for the chief year of training are for the resident to become competent in independent surgical decision-making and advanced surgical technique. To accomplish this, each resident is placed in a leadership position on general surgical services at University of Colorado Hospital, Denver Health Medical Center, Memorial Hospital-Colorado Springs and the Veteran’s Administration Hospital. Chief residents are given leadership responsibility for a surgical service and coordinate and supervise all clinical and educational activities on the service. The rotations include trauma, surgical oncology, endocrine, hepatobiliary/bariatric, minimally invasive/foregut surgery, colorectal, and general surgery as well as robotic procedures in general surgery. Since UC Denver has minimal fellows—this year is an opportunity to improve skills with primarily fellowship trained surgeons focusing on the above areas with the chief resident as the focus of each rotation. Total case experience and breakdown can be found in this document: Website case volume page 2018.pdf. To view a list of rotations for a typical experience at the University of Colorado School of Medicine Residency in General Surgery, see our 18-19 Block diagram.pdf.