The resident training program is fully accredited by the Residency Review Committee (RRC) for Surgery under the auspices of the Accreditation Council for Graduate Medical Education (ACGME). At the time of the RRC visit in November 2010, a full five year approval was granted with no citations or concerns.
Throughout the five year training program, residents assume increasing clinical responsibilities. On completion of the program, residents will possess the core knowledge expected of all surgeons and will master the fundamentals of basic science as applied to clinical surgery.
Rotations address the areas that constitute the principal components of general surgery, specifically diseases of the head and neck, breast, skin and soft tissues, alimentary tract, abdomen, vascular systems and endocrine system. The program also generously covers the comprehensive management of trauma, emergency surgery and surgical critical care. Educational programs are supported by both our expanding surgical staff as well as an excellent group of private surgeons, all of whom are general surgeons and surgical subspecialists, and all of whom have clinical appointments in the department.
Each rotation is designed to assure that the trainee receives the required experience in all the surgical specialties including cardiothoracic surgery, pediatric surgery, plastic surgery, urology, gynecology, neurological surgery and orthopedics. Experience on the anesthesiology service is also obtained. Additionally, there is a vast experience in all phases of endoscopy. This includes esophagogastroduodenoscopy, colonoscopy, and bronchoscopy. A large number of laparoscopic and thoracoscopic procedures are performed by the surgery residents as well as operative choledochoscopy.
A broad and advanced experience in pediatric surgery is obtained at the Medical Center of Central Georgia under the direction of four pediatric surgeons. The experience for residents includes all levels of pediatric surgical care, from routine hernias, appendectomies and pyloromyotomies to advanced procedures on newborn infants and pediatric surgical oncology. Like most other surgical subspecialties in the program there is no fellowship program in pediatric surgery so all of the ‘good’ cases go to the resident on the service. The Children’s Hospital at MCCG provides a full range of pediatric subspecialties, including a 12-bed pediatric intensive care unit, and a 35-bed neonatal intensive care unit.
Most of the cardiac surgery performed in this area is accomplished at the Medical Center of Central Georgia under the aegis of nine attending cardiac surgeons. There is an abundant plastic surgery experience. Trauma surgery is emphasized, as the Medical Center of Central Georgia is a Level I Trauma Center. A trauma registry is kept and approximately 150 trauma admissions are entered each month.
Transplant surgery is not performed at the Medical Center of Central Georgia, so to allow residents to have hands-on experience in this sub-specialty; a rotation has been established at Piedmont Hospital in Atlanta. Each PGY-3 resident spends one month on the transplant service at that institution.
Organization of the Surgical Service
The Surgical Teaching Service is divided into four teams, each led by a PGY-4 or PGY-5 resident under the direction of a full-time faculty member. The four chief residents alternate serving as administrative chief resident for four months. Assigned to each section are private attending surgeons in general surgery, cardiothoracic surgery, urology, plastic surgery and head and neck surgery. Three full time surgeons, one nurse practioner and two residents manage the trauma service.
A night float system exists for nightly inhouse call with a lower level (first or second year), mid-level (second or third year) and a chief (fourth or fifth year). Each resident is free of responsibilities at least one day in seven. The teaching program for surgical residents at the Medical Center of Central Georgia includes patients admitted through the outpatient surgery clinic and the emergency room. Patients are assigned to a full-time surgical faculty member or to an attending surgeon who has a clinical faculty appointment at Mercer University School of Medicine. Residents assume a major role in teaching and supervising medical students in their eight week junior surgical clerkship.
Residents in the research laboratories of the Department of Surgery have been extraordinarily productive. In October 2010 they presented four papers at the Surgical Forum of the Clinical Congress of the American College of Surgeons. To help residents sustain their interest in surgical basic science, a research rotation will consist of two months during the residents’ second year. In addition, the residents will be involved in a clinical research throughout their five years. Our goal is to provide depth to their education in problem-based learning and improvement, and to provide opportunities to contribute to the surgical literature.
This year we have expanded our didactic program in resident education. We want to incorporate faculty lectures, resident-led discussions, and journal club over our primary education day, which is Tuesday. We meet at 4:00 P.M. to review both chapters from Sabiston as well as have a resident-led question-and-answer session to present board review questions on that particular chapter. We also use the SCORE curriculum to supplement our knowledge base as it offers articles, chapters, multimedia and questions. By the end of the day, all residents have had a comprehensive, organized exposure to surgical conditions of the particular topic that will help lay a foundation for further study.
Surgical Critical Care Fellowship
The Level 1 Trauma Center at MCCG is fully designated by the Georgia State Office of EMS and Trauma, and is among the busiest in the state. Dennis Ashley, M.D., has started a fellowship in critical care, taking full advantage of trauma-critical care facilities at MCCG. Review Committee (RC) approval is complete and this year (2011) we welcome our third class of Critical Care Fellows. The program has proved a great benefit to the residency, adding to the didactic program in advanced cardiac, pulmonary and critical care. We also send third year residents to the Advanced Trauma Operative Management (ATOM) course to provide basic training in operative trauma.