The general surgery residency curriculum is a composite of basic science lectures, clinical correlation conferences, bedside teaching and progressively increasing responsibility in the operative management of patients with diseases encompassing the skin and soft tissue, alimentary tract, abdomen, vascular system and endocrine system. Complementing their education in the principle components of general surgery is instruction on the comprehensive management of trauma, burn and critically ill patients. The curriculum also ensures residents develop a fundamental working knowledge of the surgical specialties (orthopaedics, neurosurgery, urology, etc.).
The simulation curriculum is an integral part of the surgical training program at Washington Hospital Center. Residents have the opportunity to participate in simulation modules once a month in the Simulation Center, taking full advantage of state-of-the-art equipment. Residents receive training appropriate to their PGY level. Junior residents gain experience in basic tasks such as sigmoidoscopy, central line placement, chest tube insertion, airway management, response to code blue and safe hand-offs. Intermediate and senior residents work on enhancing their skills in colonoscopy, bronchoscopy, surgical airway management, and advanced laparoscopic and endovascular techniques. This comprehensive, graduated training enables residents to enhance their skills in a realistic training environment.
Specific rotations may differ slightly in their emphasis; however, all stress continuity of care and adhere to the philosophy of training a surgeon with the capacity to both “think” and “do.”
Many of the major clinical services in the Department of Surgery are organized into color-coded ‘teams.' This team structure provides an organized platform for patient care and educational activities. Each team has a faculty ‘team leader' who is responsible for assuring that all educational goals are met by residents rotating on the service.
First-year residents focus on preoperative and postoperative care. Rotations in general surgery, vascular surgery, trauma, critical care and a number of surgical subspecialties provide residents with introductory experience in the principle components of surgery.
Second-year residents continue to expand and sharpen their surgical skills. Rotations in the surgical intensive care unit and burn center focus on developing competency in all aspects of surgical critical care, including ventilator management, nutritional support, antibiotic therapy, fluid resuscitation and metabolic support.
Residents acquire significant surgical experience during rotations on the general surgery and vascular services. Rotations at Children's National Medical Center and Suburban Hospital emphasize ambulatory care and introduce intermediate-level operative cases, including hernia repair and cholecystectomies.
Year three training focuses on developing and enhancing the residents' ability to assess and care for patients with surgical disease. Residents work closely with the chief resident and the attending surgeon, to evaluate and assist in the management of more complex general surgery cases.
Rotations include general surgery, vascular surgery, surgical oncology and colorectal surgery. Residents assume responsibility for initial patient evaluation, preoperative planning and preparation, guiding postoperative care and planning follow-up care. Operative experience emphasizes graduated responsibility in moderate complexity surgical cases. The resident is exposed to a wide variety of advanced laparoscopic and endoscopic procedures, which complement the general and vascular surgical procedures.
The primary goal of the fourth year of training is to develop and enhance leadership skills, in addition to continuing to develop clinical expertise. Fourth-year residents serve as team leader of the service on which they are rotating. Duties include primary responsibility for all aspects of patient care as well as the education of junior level residents.
Residents spend ten weeks on trauma, thoracic surgery and transplant surgery at Washington Hospital Center. They spend ten weeks at Georgetown University Hospital on the Hepatobiliary/Transplant Service and ten weeks with advanced laparoscopic surgery at Washington Hospital Center.
A rotation on the trauma service is an opportunity for the fourth-year resident to be trauma team leader. In this role, he/she manages and directs members of the team, coordinates a treatment plan for each patient, serves as the primary operating surgeon and oversees postoperative care. The team leader, under attending supervision, also conducts his/her own clinic and provides the necessary follow-up care.
While on the General Thoracic Surgery service at Washington Hospital Center, residents care for patients with a wide variety of non-cardiac thoracic pathology. Residents have the opportunity to interact with patients in the outpatient setting, emphasizing the importance of continuity of care.
The rotation at Georgetown University Hospital provides significant experience in the mechanics and physiology of liver failure, management of immunosuppression, organ procurement, liver / small bowel transplantation and hepatobiliary surgery.
The final year of residency is devoted entirely to general surgery and its core components. Chief residents rotate on each of the five general and vascular surgery services at Washington Hospital Center. Along with perfecting their surgical judgment and skills, chief residents are active in the education of junior residents and core medical students. Chief residents supervise junior residents in the overall care of surgical patients, as well as regularly lead discussions at conferences.
During his/her rotation on the green team, the chief resident has primary responsibility for the staff service. This is a unique opportunity for the chief resident to act in the role of a junior attending, under the direct supervision of a faculty member. The resident has the opportunity to manage a variety of complex problems, both on an inpatient and outpatient basis, with the “safety net” of a staff surgeon who is available for consultation, as needed.