Surgery Curriculum

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.

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 our second years are given leadership roles on our acute care/general surgery service. 

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. 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 also occurs 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 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 fifth year is truly a finishing year, honing both operative and leadership 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

This is our Chief resident run General Surgery service at our program, led by a chief resident along with an intern and an experienced nurse practitioner. 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 urgent or elective cases 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. 

General Surgery Blue (Minimally Invasive Surgery)

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.

Hepatobiliary Service – Main and Northeast Hospital

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 rotation with cutting edge surgical techniques including Microwave ablation procedures, open hepatectomies, robotic whipples, hepatectomies and duodenal resections. Particularly upper levels residents work one on one with fellows and attendings.

GI Surgical Oncology / Colorectal Surgery (SOCRS)

Residents typically rotate with the GI surgical oncologists and Colorectal Surgeons with the team typically consisting of a junior (PGY-1 or 2) and a senior (PGY-3-5) resident. This rotation is designed as an apprenticeship model. During this month, residents gain significant exposure to perioperative management of esophageal, gastric and colorectal malignancies.  Notably, residents gain exposure to a minimally invasive approaches to complex GI cancers, in addition to benign procedures for Crohns and anorectal pathology.

Breast/Soft Tissue Oncology 

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 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 and breast journal club.

Pediatric Surgery

The pediatric surgery rotation consists of a PGY-4 functioning as the service chief and a PGY-1. Operative exposure ranges from bread-and-butter appendectomies to complex neonatal cases. Residents gain operative experience on this rotation and are tasked with management of complex pediatric perioperative patient care. Despite a busy pediatric hospital, there are no pediatric surgery fellows. Residents rotate with the Pediatric Surgery Associates group, and PGY-4s perform index cases such as CDH repair, anorectal malformation repair, Ladd’s procedures, and oncologic resections. Many of the cases performed on this rotation are via a minimally invasive approach. This is a high-volume service and residents become comfortable approaching and working up pediatric surgical patients.

Trauma/STICU/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

Residents typically spend two months during their second year and one month during their third year on the SCC service.  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.

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.

Emergency General Surgery – CMC Main and AH University

The Emergency General Surgery Services (EGS) at Main and University Hospital focuses solely on patients coming in through the ED of our 900-bed acute care facility. Led by PGY2 who functions as the chief of the service. 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 EGS 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.

Pineville Services Experience

Residents rotating at Pineville get a diverse clinical experience involved in the care of colorectal surgery, soft tissue oncology and CT and vascular surgery. Educational conferences include a multidisciplinary tumor boards and journal clubs.  

Mercy Surgery Service

Atrium Health Mercy is an additional hospital within our system that is located less than two 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 residents from the General Surgery Red rotation, or residents assigned to the 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.          

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. 

Thoracic Surgery

Residents spend one month rotating as a PGY 3 or 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 can scrub on the cardiac side, taking part in minimally invasive and open CABG, valve repairs, LVAD and heart transplant. Atrium Health functions as a congenital heart repair center, as well as a heart transplant center therefore available cardiac surgical experiences are vast.

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 oversees admissions, consults and surgical procedures, along with management of floor patient from the general surgery teams.  

Elective Rotations

Our curriculum allocates a total of three months toward elective rotations during the PGY 3, 4, and 5th years.  We strive to provide elective rotations that interest residents and help cultivate a favorable career path.  Of most importance is offering residents a space to explore their career options, connect with a professional mentor, fine-tune their skill sets and develop a plan that delivers them the career of their choice.

Examples of elective rotations over the past two years include: