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The curriculum of the General Surgery Residency Program at Carolinas Medical Center has been developed to build on the strengths of our diverse faculty, our immense clinical volume and innovative educational programs. The learning platform is based on focused education in the basic sciences, clinically centered conferences to develop practical and critical thinking skills, simulation for technical and cognitive development, multidisciplinary conferences to broaden understanding of complex topics, ABSITE® and oral-board prep conferences and other innovative educational methods.

The core of any surgical training is the clinical experience. Our residents begin their operative experience at the very onset of their residency and become accomplished technical surgeons well before finishing our program. Our goal is to continually refine the residency program through ongoing performance-improvement analysis and needs assessment. An important part of this process is allowing residents to contribute their own ideas for advancing their education.

Nearly all clinical rotations are housed in the main campus hospital of Carolinas Medical Center. The only rotations outside the main campus are only a few minutes’ drive away.

Core Rotations

PGY-1

The PGY-1 year provides early operative experience. New residents are matched with a faculty mentor to ensure a smooth transition to their new lifestyle. Extensive experience in the essentials of pre- and postoperative care for the surgical patient provides an essential foundation for growth in subsequent years. The PGY-1 resident spends time on rotations in trauma surgery, general surgery, surgical oncology, minimally invasive surgery, hepatopancreatobiliary surgery and pediatric surgery. All of these rotations are housed on Carolinas Medical Center’s main campus.

PGY-2

As operative experience increases in the second year, so does clinical responsibility. The PGY-2 resident receives extensive experience in surgical critical care. In addition, diagnostic and management skills are further developed during the night float rotation (two non-consecutive months per resident), a schedule designed by residents to best suit our program. Other rotations in the PGY-2 year include minimally invasive surgery, transplant surgery, surgical oncology and acute care/general surgery. The PGY-2 resident also receives extensive endoscopy experience.

PGY-3

The third year continues development in critical care, with rotations in both the trauma ICU as well as on the non-trauma Surgical Critical Care service. In addition, the PGY-3 resident serves as the chief resident of the Emergency General Surgery service, obtaining extensive operative experience while managing perioperative issues in close consult with acute care surgery attendings. This early leadership role, accompanied by active mentoring, serves residents extremely well as they continue to progress into the senior levels of residency. Rotations on the acute care, vascular, minimally invasive, transplant, and hepatopancreatobiliary surgery services, as well as an elective month, round out the third year. Significant endoscopy experience continues to be gained in the third year.

PGY-4

The PGY-4 resident is the chief resident of both the trauma service and the Pediatric Surgery service.  They also rotate in thoracic surgery, hepatopancreatobiliary surgery and surgical oncology.

PGY-5

Chief residents in our residency program function with great autonomy. As the chief resident of the general surgery service, the resident manages the clinic, sees consults, schedules operative procedures, follows patients post-operatively and truly runs a group practice with fellow chief residents.This is an invaluable experience and prepares the chief resident to enter into practice seamlessly upon completion of the residency. The PGY-5 also functions as the chief resident of the surgical oncology service and spends time in an apprenticeship model with individual attending surgeons in the division of minimally invasive surgery. The colorectal surgery rotation during the PGY-5 year is based at CMC-Mercy hospital, a short distance from the main campus. The fifth year is truly a finishing year, honing skills and preparing residents to practice independently without supervision. Each chief resident also assumes an administrative role in the residency, organizing departmental conferences, managing Grand Rounds, or planning ABSITE® prep sessions.

 

Surgery Rotation Descriptions

General Surgery Red

Chief run General Surgery service at our residency program, led by a chief resident along with a midlevel resident (PGY 2/3) and an experienced nurse practioner.  Patients often represent the most complex or highest acuity general surgery patients transferred in from Atrium’s 44+ hospital network system.  Surgical exposure is vast but mainly focuses on emergent general surgery cases as well as elective schedule cases from our sliding scale payment clinic.  Patients are referred from other surgeons and specialists across the city, from our Morehead Medical and Myers Park clinics, and inpatient consults.  This service offers high operative volume, focus on clinical workup/decision making, and resident operating autonomy.  Attendings covering this service include the program director Dr. Green, Chairman of Surgery, Dr. Matthews, Dr. Schiffern, Dr. Paton, Dr. Reinke and Dr. Stewart.

 Emergency General Surgery (Grey)

Our second emergency general surgery service which focuses solely on patients coming in through the ED of our 900 bed acute care facility.  Led by PGY-2/3 who functions as the chief of the service with a PGY-1.  Operative cases come from emergency department consults and mainly consist of bread and butter surgery including cholecystectomies, abscesses, small bowel obstructions, and appendectomies.  Additionally, the Grey team assists with cases needing to be performed on the trauma service and surgical critical care service such as reopen laparotomies, tracheostomies, and PEG placement. 

Mercy Surgery Service

Atrium Health-Mercy is an additional hospital with in our system that is located less than 2 miles from our main campus.  An additional general surgery services operates here and is usually run by an attending and an advanced care practitioner.  Cases are covered by the mid-level on the General Surgery Red rotation, or residents on their elective rotation at Mercy.  Starting as PGY-2, residents begin covering overnight floor and emergency department call.  Residents as responsible for seeing and evaluating patients, as well as operating at night for emergency cases.  This is a great rotation in building autonomy early for our young residents.  

Trauma/TICU/Trauma Chief

As the only Level 1 Trauma Center in the booming Charlotte Metropolitan area, trauma is one of the busiest services. Residents rotate on trauma as a PGY-1, in the trauma ICU (TICU) during PGY-2 and 3, and as trauma chief as a PGY-4. Off-service residents from Emergency Medicine, Orthopedic Surgery, Urology, and Neurosurgery residencies also rotate as trauma interns and TICU residents. Educational activities during this month include daily morning checkout, which reviews overnight admissions and cases, as well as trauma M&M conference and Surgical Critical Care grand rounds. Clinical duties are shared with a team of Advanced Care Providers/Nurse Practitioners. 

Surgical Critical Care (SCC)

Residents typically spend 2 weeks during their TICU month rotating on Surgical Critical Care along with SCC Advanced Care Providers/Nurse Practitioners. During this time, residents gain additional exposure in critical care management and become more familiar with disease processes of other surgical subspecialties including CT and Vascular surgery, ObGYN, Transplant, Head and Neck and Plastic Surgery. Residents also participate in regular didactics each week at Surgical Critical Care Grand Rounds.  

Night Float Surgery

General Surgery at Atrium health does have a dedicated night resident float system, which is run by three total residents (at home Chief Resident, PGY2/3 and a PGY1).  The night float team is in charge of admissions, consults, surgical procedures along with management of floor patient from the general surgery teams.  Residents work from Sunday night to Thursday night. 

General Surgery Blue (Colorectal)

Residents rotating on the Colorectal Surgery service typically work in an apprenticeship model with two colorectal surgeons, Dr. Davis and Dr. Kasten.   Surgeries range from benign colorectal procedures for Crohns, anal fissures and hemorrhoids, to total abdominal colectomies and oncologic resections for malignancies. Educational conferences include a multidisciplinary tumor board and colorectal journal club.

General Surgery Blue (Minimally Invasive Surgery/Hernia)

Residents from each class along with fellows rotate on the MIS/Hernia service.  This service works as an apprenticeship model, as residents work one-on-one with attendings in clinic and during operative cases.  Chief residents are treated as fellows on the rotation and responsible for running the service, but there are operative cases for all levels. Surgeries include laparoscopic and open hernia repairs to complex abdominal wall reconstructions.  The department is currently run by Dr. Heniford, a world-renowned hernia surgeon and previous president of the Americas Hernia Society.  Additionally, cases such as adrenalectomies, robotic hernia repairs, donor nephrectomies and advanced endoscopic surgeries (LYNX Device, POEM) are regularly performed.

General Surgery Purple (HPB Surgery)

HPB Surgery at Atrium Health is a busy service containing a magnitude of disease process which include aspects of surgical oncology and management of benign hepatobiliary pathology.  Normal patient census usually ranges into the 15-25 patients. The team normally consists of two residents (PGY 3/4 and a PGY 1/2), multiple Advanced Care Practitioners, and an HPB Fellow.  Surgical experiences are vast during this rotations with cutting edge surgical techniques including Microwave ablation procedures, open hepatectomies, along with robotic whipples, hepatectomies and duodenal resections.  Particularly upper levels residents work one on one with fellows and attendings.

Breast/Soft Tissue

Residents from every PGY class spend time rotating on the breast/soft tissue surgical oncology service.  This provides an opportunity to gain exposure to the surgical oncology practices of breast cancer and soft tissue cancers including melanoma, squamous cell carcinoma and basal cell carcinoma.  During this month, residents also spend time with Dr Wagner, a private practice surgeon who performs hundreds of parathyroidectomies and thyroidectomies each year. Resident will work one on one with attendings during surgery and clinic. During this month, regular conferences include breast and melanoma tumor boards, ultrasound conference, as well as breast journal club.  

Head and Neck Surgery

PGY-4 resident will rotate on the head and neck surgical oncology service.  This service is also supported by advanced care practitioners who assist in clinic, floors and the operating room.  Residents will gain experience in general surgery procedures such as tracheostomies and thyroidectomies as well as complex surgical resections of the face and neck such as parotid gland resections, mandibular and complex oral cavity resections with microsurgery reconstructions.

Plastic Surgery

Residents spend 2 months as a PGY 2 and PGY 3 working with the plastic surgery department.  The in-house plastic surgery staff is mainly a reconstruction department.  Residents gain extensive exposure to flap reconstruction in the setting of oncological breast surgery, along with facial reconstruction and tissue rearrangement flaps for soft tissues malignancies.  Recently we have added experience at a local cosmetic surgeon (Hunstad/Kortesis) in which residents have a chance to gain experience in the private plastic surgical setting.           

Surgical Oncology

Residents typically rotate with GI surgical oncologists with the team typically consisting of a junior (PGY-1 or 2) and a senior (PGY-3-4) resident. This rotation is designed as an apprenticeship model and during this month, residents gain significant exposure to perioperative management of esophageal, gastric and colorectal malignancies, including multidisciplinary tumor board. Notably, residents gain exposure to a minimally invasive approach to complex GI cancers.

Vascular Surgery

The Vascular surgery rotation at Atrium Health is part of the Sanger Heart and Vascular Center.  PGY2 and PGY4 residents spend one month on the rotation.  This is designed to expose resident early to the fundamental principles of vascular surgery and a combination of open and endovascular exposure.  Residents work directly with ACPS and Fellows on this very busy service.

Transplant Surgery

Transplant Surgery at Atrium Health is one of six transplant programs in the U.S. with its own hospital-based procurement program and is one of the busiest transplant programs in North Carolina. During this rotation, the resident (PGY 2 or 3) work closely with attending surgeons specializing in liver, kidney and pancreas transplants and are heavily involved in procurements, living donors and solid organ transplants. Resident responsibilities also include taking home call and holding the transplant pager. Clinical duties are shared with 4 PAs who assist with floor and surgical coverage. There are no fellows or chief residents on the service, providing an unprecedented opportunity for PGY2 and 3 to be first assist on all cases.

Thoracic Surgery

Residents spend two months rotating as a PGY-3 and PGY-4 on the Cardiothoracic surgery service.  Residents work one on one with attendings through majority of thoracic cases including; VATS, wedge resections and formal lobectomies.  Additionally, residents have the ability to scrub on the cardiac side, taking part in minimally invasive and open CABG, valve repairs, LVAD, and heart transplantation.  Atrium Health functions as a congenital heart repair center, as well as a heart transplant center therefore available cardiac surgical experiences are vast.

Pediatric Surgery

Currently there are two separate rotations for pediatric surgery at Atrium Health.  One rotation consists of a PGY-4 functioning as a chief and a PGY-1 (Pediatric Surgical Associates), while the other is either a PGY-1/PGY-2 (Atrium Health Pediatric Surgery).  Cases on these services range from bread and butter to complex neonatal cases.  Residents gain operative experience and are tasked with continued management of complex pediatric patient preoperatively and postoperatively.  Despite a busy pediatric hospital, there are no pediatric surgery fellows -- with Pediatric Surgery Associates, PGY4s perform index cases such as CDH repair, anorectal malformation repair, Ladd’s procedures, and oncologic resections, often with a minimally invasive approach.  There is a weekly pediatric surgery didactic conference for residents on the services.  

Chief Rotation Colorectal Surgery at CMC-Mercy

A true apprenticeship rotation, chief residents spend 2-3 months working one-on-one with Dr Dobson, a private practice colorectal surgeon. The chief resident will perfect his or her colorectal surgery knowledge base and operations, from complex Crohns fistula takedowns to benign anorectal disease. Dr. Dobson has won several teaching awards, and this rotation allows chief residents to hone their operative skills (open, laparoscopic, robotic) in a unique private practice setting.

Selective Rotations

We work hard to provide elective rotations that residents are interested in and will help them along their desired career path. Our residency is unique in allowing 3 months of total elective time in the PGY 3, 4, and 5th years. This allows residents to explore career options and build their skillsets.

Below are some examples of selective rotations over the past two years:

Rural Surgery in Shelby, NC
CMC Mercy General Surgery
Bariatric Surgery - Charlotte, NC
General Surgery at Mukinge Mission Hospital, Kasempe, Zambia
General & Laparoscopic surgery in Boise, Idaho
General & Laparoscopic surgery in Jackson, MIssissippi
Cardiothoracic Surgery at the Univeristy of Viriginia
Pediatric Surgery in Kansas City
HPB & General Surgery in Savannah, Georgia
MInimally Invasive Surgery in New York
Cosmetic Plastic Surgery - private practice, Charlotte, NC
CMC Pediatric Cardiothoracic Surgery
CMC Head and Neck Oncology
Ultrasound at CMC Emergency Department

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