Residency in General Surgery at Vanderbilt
The Department of Surgery offers twenty-four first-year positions as surgical house officers through the National Residency Matching Program. Eight of the first-year positions are categorical general surgery positions while sixteen are one- or two-year preliminary positions for house officers interested in various specialties.
Five clinical years comprise the General Surgery Residency Program. All aspects of diagnostic workup, preoperative preparation, intraoperative judgment and surgical technique, postoperative management, and follow-up care are stressed. The wide variety of clinical problems presented at this multi-hospital complex allows each individual an ample opportunity to observe and experience first-hand the complexities of the response of the surgical patient to disease, trauma, and operative intervention. The first two years emphasize a breadth of experience with one-month or five-week rotations. The final three years provide in-depth experience with rotation duration being five to eight weeks. In addition to the five clinical years, an opportunity for two or more years of laboratory investigation is provided for each categorical resident.
The first year (PGY 1) trainees rotate through all three hospitals. The PGY 1 resident functions as a member of a surgical care team. Responsibilities include evaluating and planning for treatment of patients, attending rounds, outpatient clinics, and conferences, assisting in the operating room, and participating as a member of the educational staff for junior and senior medical students during their surgical clerkships.
While junior house officers acquire significant responsibility, close supervision and backup by more senior house officers and faculty are provided. PGY 1 residents are trained to assume daily primary care responsibility for patients on their service, to understand the complex problems of critically ill patients, and to perform the mandated interventions.
A major goal of the Department is to train the novice surgeon to understand the principles of pre- and post-operative care. The PGY 1 should gain valuable operating room experience both as an assistant and an operating surgeon working under close senior supervision. For the PGY 1, some rotations are home-call based; others may be in-house every third or every fourth night.
Regardless of career track, all PGY1 residents gain equivalent experience and exposure during the first year. Rotations in general, vascular, and pediatric surgery comprise six to seven months of the experience. The remaining rotations provide surgical intensive care unit and emergency room experience for residents, with special rotations possible on hepatobiliary, neurosurgery, plastic surgery, otolaryngology, orthopaedic surgery, urologic surgery, burn unit and anesthesia.
During the second (PGY 2) postgraduate year, rotations are of five weeks' duration. Rotations include opportunities for experience at the associated hospitals in the following areas: general surgery, vascular surgery, cardiothoracic surgery, renal transplantation, critical care, and trauma. On the General Surgery services the operating experience broadens to include opening and closing laparotomy wounds, repairing more complicated hernias, some trauma, and less complicated biliary procedures. An increasing amount of clinical independence is expected and achieved. PGY 2 residents also acquire advanced trauma life support training.
During the third year (PGY 3) the resident assumes greater decision-making responsibility through consultation opportunities and as the senior resident on the renal transplantation and burn services. Rotations (6.5 weeks in duration) include general surgery, renal transplantation, hepatobiliary and bariatric surgery, burn surgery, pediatric surgery, and endoscopy.
In addition to the five years of clinical general surgery training, categorical residents are encouraged to spend at least one year as a resident in research, but most spend two years. Opportunities for clinical as well as basic science research abound. Several of our residents have completed masters degrees during the two research years. Occasionally residents spend three years in order to satisfy the requirements for a Ph.D. The facilities of the S.R. Light Laboratory for Surgical Research of Vanderbilt Medical School and the Surgical Research Laboratory at Nashville Veterans Affairs Hospital are made available to the residents throughout their training. The residents are also encouraged to participate in various clinical research projects in collaboration with the faculty. Qualified and interested residents may apply their research experience toward fulfillment of a Ph.D. program in basic sciences, a Master of Science in Clinical Investigation, or a Masters of Public Health.
The fourth year (PGY 4) continues the gradual assumption of increased leadership, decision making, and responsibility. Fourth year residents are the senior residents on the trauma and pediatric surgery rotations. Additional rotations where they serve as senior assistant residents include general surgery, vascular surgery, and thoracic surgery.
The Chief Residency year of the General Surgery program provides increasing senior-level responsibility in patient-care decision making, teaching, and education, and promotes the mature judgment essential for surgical practice. Each chief resident rotates through Vanderbilt, the VA, and presently Saint Thomas hospitals. Rotations are seven and a half weeks in duration.
The chief resident is required to prepare and present at conferences and is responsible for the teaching and training of more junior house officers and students on his or her service. The chief resident is involved with major elective procedures emphasizing complex gastroenterologic, oncologic, endocrinologic, and peripheral vascular cases. The chief resident is responsible for the management of all the patients on his or her service. Requests for surgical consultation from other clinical departments are channeled through the chief resident.
The final year of the General Surgery experience completes a progressively graded comprehensive training program of increasing responsibility as required by the American Board of Surgery.
Chief Residents participate in administrative roles within the department and attend departmental graduate medical education meetings, coordinate call schedules, and work closely with the Surgery Education Office.
In-Service Training Examination
Each year all Department of Surgery residents participate in the In-Service Training Examination sponsored by the American Board of Surgery (ABSITE). This test is given nationally by all departments of surgery to evaluate each individual resident’s progress. These examinations assess the resident’s surgical fund of knowledge and are a reasonably good predictor of performance in the American Board of Surgery qualifying examination.
Each year the faculty members of the Department of Surgery administer a practice oral examination to the senior residents to prepare them for their certification examination. Graduates of the Vanderbilt Surgery Residency Program have consistently demonstrated a high level of proficiency in both the qualifying and certifying examinations.
The performance of each resident in the Department is regularly evaluated by faculty members on their respective rotations. Faculty evaluation records are forwarded to the Surgical Education office each rotation. Residents are expected to maintain the standards of the Department. The residents are also asked to evaluate each of their rotations and the faculty.
Additional Educational Opportunities
In July and August, Friday teaching conferences are devoted to orienting the interns to the basics of surgical patient care. Teaching conference lectures are presented by the chief residents. These "summer school" topics focus on practical skills, incorporate skills labs, and help orient one to the Vanderbilt Surgery Residency Program.
All surgical residents and medical students are expected to attend the weekly Residents' Teaching Conference. This conference stresses basic science and its clinical applicability. Grand Rounds and the Residents' Teaching Conference are both held on Friday morning.
Other courses are offered throughout the year, such as surgical skills courses. This techniques course presents a progression of increasingly more demanding skills. Over the course of a five-year residency, an individual can begin with knot-tying, suturing, and tissue handling techniques and, by the fifth year, can learn advanced laparoscopic surgical techniques.
Each of the hospitals in the Vanderbilt Surgery Residency Program conducts teaching conferences to enrich the educational experience.
For additional information regarding the terms, conditions, and benefits of appointment, visit GME Office - section for Residents/Clinical Fellows.
To view the current House Staff Agreement form, click here.