Education of the next generation of surgeons is accomplished best through a multifaceted approach of simulation, didactic opportunities, discussion, hands on experiences and frequent feedback. A major philosophical change in medical education has occurred in the centennial year of the Carnegie Foundations ground-breaking Flexner reports. A new Carnegie Foundation Report on Educating Physicians was released (N Engl J Med 2006;355:1339-44). One major tenet of the report was a call for more "active learning" techniques.
In October 2011, Dean Parmellee MD was invited to the USA College of Medicine to give a conference on one technique of active learning called "Team Based Learning". Many faculty within the department of Surgery attended this conference. The Department of Surgery was also represented for more advanced training on the Team Based Learning collaborative meeting in Florida.
Following this background, we initiated a new philosophy in the deliverance of surgical education. We restructured the design of all conferences to initiate "Active" learning rather than the previous lectures that were passive learning. The previous lectures are now facilitated discussions based on the pathophysiology and management of surgical conditions. These case-based discussions in the basic science conferences are facilitated by a different resident each week. A faculty member with expertise in the area of the topic, along with Dr. Simmons (Program Director), reviews the resident's case-based presentation prior to the conference. The expert faculty member and Dr. Simmons are present during the educational conference for clarification and extra teaching during the facilitated discussion. The educational chief resident is also required to review the material and develop a multiple choice test for the residents to take following the answer the multiple-choice test. The answers are reviewed immediately to ensure maximal learning potential from the exercise.
Our residents are taught to be aware of the larger context and system of health care and in effectively using system resources to provide care that is of optimal value. We plan our program around clinical rotations, research and educational opportunities in order to achieve appropriate skills in these competencies. The University of South Alabama Graduate Program in Surgery is a 5-year educational program which includes experience to all of the specialties and subspecialties of Surgery, with clear goals and objectives for each experience.
The First Year Emphasized the Physiologic and Metabolic. Rotations in the PGY 1 include Acute Care Surgery, Surgical Intensive Care Unit, Colorectal Surgery, General Surgery, Neurosurgery, Laparoscopic Gastrointestinal, Nights and Burns in one and two months increments.
During the first year (PGY 1), exposure is provided to all aspects of pre and postoperative care with emphasis on the physiologic and metabolic problems that occur in all surgical patients. Operative experience is acquired through presence in the operating room assisting and performing surgical procedures. There is also extensive experience in the placement and use of invasive monitoring devices. These experiences occur at the University of South Alabama Medical Center (USAMC), a tertiary care hospital with a Level 1 Trauma Service, and Regional Burn Unit. During the PGY 1, residents will complete a self-directed, soft tissue skills lab, gastrointestinal stapling lab, and open surgery skills lab.
The Second Year Focuses on endoscopy, and development of basic operative skills
In the second year (PGY 2), in addition to rotations on the Acute Care Surgery Service at the USAMC, residents go to the Veteran's Administration Medical Center (VAMC) in Biloxi MS. Residents will be provided housing and food while at the VAMC, and will obtain experience in the treatment of patients in a managed care setting. In addition to patient care and operating room experience, the resident will obtain an extensive experience in flexible endoscopy. Rotations at USAMC on the GI service and cardiovascular serve provide ample operative experience as surgeon and first assistant. Each resident also rotates at USA Children’s and Women’s Hospital on the pediatric surgical service. Where they develop clinical skills in the pediatric population and add to their case log in less complex pediatric surgical cases. Rotations include VA, GI Surgery, Cardio & Thoracic, Night Float, and Pediatric Surgery for 10 weeks.
Increased Responsibility in the Third Year. Rotations include Colorectal Surgery, General Surgery, Trauma, Pediatric Surgery, Vascular Surgery. All rotations are for 10 weeks.
In the third year (PGY 3), the resident will again rotate onto the USAMC's Trauma/Acute Care Surgery, and on the general surgery service when they will increase the complexity of cases performed while acting under the direction of senior level residents. They also return to CWH's Pediatric Surgery Service where the resident will have increased responsibilities both in patient care and in the operating room and serves as the chief resident on the pediatric surgery service. Residents obtain exposure to surgery at the Mobile Infirmary Medical Center (MIMC), a large private hospital located 10 minutes from the main University of South Alabama Medical Center. During these rotations, residents will get extensive operating room exposure assisting and performing surgical procedures and experience caring for patients outside of a University based, tertiary care setting. They spend time on the vascular service and on the surgical oncology service.
A one month transplant rotation is done at the University of Mississippi Medical Center in Jackson Mississippi while on the Vascular rotatation, where they learn about all aspects of surgical care for liver and kidney transplant patient. They are integrated fully into the rotation and learn specific operative techniques for solid organ transplantation.
Patient Care and Operating Room Experience Mark the Fourth Year. Rotations include Trauma, Night Float, Cardo & Thoracic, Elective, and Surgical Oncology. All rotations are 10 weeks.
The emphasis during these rotations is on patient care and operating room experience. The PGY 4 experience will also include senior level rotations on the USAMC's Cardiovascular/thoracic, Acute Care Surgery service and Intensive Care Unit where the resident will have advanced responsibilities including the supervision of the junior residents on these services. They also serve as the chief resident on the night float service and supervise the junior level residents and admit trauma and acute surgical patients. At the end of the PGY 4 year, residents will be expected to have met both the case number and defined category requirements for certification by the American Board of Surgery.
Year Five Emphasizes Health Care Team Leadership and Increased level of operating skill
In the fifth (PGY 5) or Chief year, residents will again rotate to the USAMC's laparoscopic GI/oncology service, the colorectal service, general surgery service and endocrine service where the resident will obtain experience as the leader of a complete health care team including junior residents, nurse practitioners, medical students, and other personnel in addition to obtaining additional experience in patient care and in the operating room. In the Chief year, residents will obtain extensive experience in administration being responsible for work and vacation schedules for the other residents, and in organizing resident educational activities. Operative cases include increasing complex operations often reserved for fellows in other surgical departments.
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