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Residency Program Details

UIC's five year long, Residency Program, residents participate in a balanced experience involving three major integrated teaching hospitals and two affiliated hospitals. Seven categorical general surgery residents are recruited each year. The program is approved for 22 R-1 residents which include seven categorical residents and 15 designated preliminary residents. The program is approved to graduate seven categorical chief residents.

After the PG II year, residents may competitively opt to enter into a two or more year program of research. Although not mandatory, residents who decide to use this time to actively participate in research activities are encouraged to enroll in the Graduate College to concomitantly obtain their M.S. in Surgery..

Residents can expect to perform a large number of operative procedures under the supervision of the attending staff. Residents are also involved in didactic and clinical teaching experiences that provide well-rounded training. Each year, residents are required to take the In-Service Examination of the American Board of Surgery. After satisfactory completion of the program, residents become eligible to take the American Board of Surgery Examinations, and are eligible for additional training in surgical subspecialties.


Select the appropriate link below, for commentary on year-by-year residency programs:

FIRST YEAR

 


Rotations during R-1 year

  1. General Surgery
  2. Surgical Oncology
  3. Minimally Invasive Surgery
  4. Pediatric Surgery
  5. Colon and Rectal Surgery
  6. Vascular Surgery
  7. Plastic Surgery
  8. Urology
  9. Trauma and Critical Care
  10. Transplant Surgery
Goals
  • Proficiency in the preoperative and postoperative care of surgical patients
  • Proficiency in basic surgical technical skills including both minor procedures and operations appropriate for intern level experience
  • Proficiency in the principles of adult, clinical education
  • Proficiency in the management and leadership of a ward service, utilizing the cooperative skills of medical students, nurses and ancillary personnel
  • To develop a knowledge base of the fundamentals of surgical pathophysiology

Objectives

Demonstrate proficiency in the three general categories:

  1. Knowledge of Surgical Disease
  2. Patient Care and Management
  3. Surgical Technical Skills
1. Surgical Knowledge is built through reading the appropriate sections in the recommended textbook, Sabiston’s Textbook of Surgery, and through the surgical conferences as well as, through managing the ward service during various rotations within the system. This occurs under the guidance of senior residents and attendings.

2.

Patient Care and Management Skills are acquired through skill development in decision making toward the day-to-day care of the ward patients under the guidance of supervisors. Depending on the severity of the problem, you may need to get help earlier in particular situations. We encourage independent thought and action once you are completely comfortable with the idea that, the problem lies within capability range and skill set. As in all rotations within the system, you are expected to evaluate problems, develop a plan and then consult with the next level of supervision. When in doubt, ask or consult your senior resident.

3.

Surgical Technical Skills, like any other psychomotor skills, will develop gradually with instruction, practice and feedback. During the internship year, we expect that, you will become proficient with foundational procedures such as phlebotomy, N access, cut-downs, central line placement, NG tube placement, tube thoracostorny (chest tubes), and diagnostic peritoneal lavage. Basic operative procedures appropriate for the intern year include, but are not limited to:

 
  • Inguinal, femoral and umbilical herniorrhaphy
  • Incision and drainage of skin and sub Q abscess
  • Excision of soft tissue lesions of the skin and subcutaneous space
  • Amputations BKA, AKA, digits
  • Anorectal procedures such as hemorrhoidectomy, fistulotomy
  • I and D of abscess
  • Management of traumatic lacerations, burns and abrasions


SECOND YEAR

 

Rotations during R-2 year

  1. General Surgery
  2. Trauma Surgery
  3. Surgical Critical Care
  4. Transplantation
  5. Cardiothoracic Surgery
  6. Vascular Surgery
  7. Burns
General Goals and Objectives

This year is designed to train you as an intensively while acquiring additional general surgical operating skills. You should be able to manage critically ill patients in a variety of situations including pre-operative stabilization and post-operative care in the Intensive Care Units. These conditions include:

  • Trauma
  • Critical conditions including sepsis, respiratory failure, renal failure
  • Cardiac emergencies
  • Transplant patients
  • Basic anesthetic management


Knowledge of Surgical Disease

You will be expected to build upon your knowledge of the pathophysiology and treatment of critical illnesses by attending conferences and rounds, as well as, reading appropriate sections in various texts such as, Sabiston’s Textbook of Surgery, ACS Principles of Surgery, Schwartz’s Manual of Surgery and, Civetta's Textbook of Critical Care. Most importantly, you develop the ability to evaluate symptoms, interpret data, formulate a plan, and often, begin to act on it, before help can arrive. This is the essence of the system of progressive responsibility that is mandatory towards effective surgical training.


Care and Management Skills

In this year, you begin to develop leadership qualities within a surgical team as you direct junior residents and students within your role of immediate supervisor.  ER and the intensive care units may be especially demanding, in this area. Here, you will be making critical decisions and directing your helpers on a minute-by-minute basis. The ability to lead with conviction while employing good will and, sometimes, with a dose of humor, is the portrait of a valuable leader who remains effective in difficult situations. You will develop increased sensitivity in the skilled management of critical psycho-social situations. You will fulfill your role as the primary professional contact for patients and their family members within the ER and intensive care units and may be called upon to deal with the following matters:

  • Revealing bad news, such as telling families that their loved ones are critically ill or have died.
  • Managing patients with a variety of challenging emotional states including grief, fear, intoxication or psychosis.


Technical Skills

As an intern you most likely performed most of the procedures commonly employed in the ICU and the ER. In this year, you will perfect those techniques through repetitive exposure. More importantly, you develop an in-depth understanding of the pathophysiology of the patient through interpretation of data. Devices utilized include pulmonary artery catheters, ICP monitors and ventilators which require correct settings and usage procedures. You will perform operative procedures such as laparoscopic cholecystectomy, basic laparoscopy, hernia repair, amputations, skin grafting, vascular access, excision and biopsy of soft tissue infections and masses.

The specific goals and objectives of rotations, that follow, recall what you have mastered from objectives, knowledge, skills and attitudes as, previously described on similar R1 rotations.

 

 

THIRD YEAR

Rotations during R-3 year

  1. General Surgery
  2. Vascular Surgery
  3. Endoscopy
  4. Transplant Surgery
  5. Surgical Oncology

General Goals and Objectives

  • Continue to build an expansive knowledge of common general surgery conditions.
  • Further develop technical skills within the operating room.
  • Develop leadership skills involved in the management of a busy service.
  • Develop as a teacher, of junior residents and students.
  • Develop effective skills as a valued consultant.

This year puts you in the driver's seat on two fast tracks. One is in the operating room as, the primary surgeon on many more cases, and another within the wards and ICU as the manager of the services. In the system of progressive and graduated responsibility, this year represents one of your most formidable steps. Additionally, you will become the primary consultant for many referring services. As in other years, you will, hopefully, attain these goals through repeated patient contact. You will increasingly use your independent judgment, with the understanding that "back-up" us immediately available. In order to make the transition into this difficult and challenging year, organizational skills are essential. You will organize your administrative chores, learning resources and even your personal life. Many are unpleasantly surprised by the fact that the R3 year means more rather than fewer hours. You should realize the promise of operating with confidence. You may be propelled through the year's challenge as you realize improved skills in patient care and find rewards in teaching others.

Knowledge of Surgical Disease

  • Utilize common atlases, texts and the surgical literature to build a strong knowledge base.
  • Become proficient in your use of educational resources.
  • Refine skills in computer usage towards improved data recording, resources and literature while searching and preparing manuscripts and/or presentations.

Your surgical knowledge will be built upon reliance upon reliable surgical texts, operative atlases, monographs and other resources and literature. Having a copy of your favorite atlas, abdominal surgery text and "Selected Readings in General Surgery", close at hand, is essential as you prepare to answer urgent clinical questions. You may be required to contribute with spur-of-the-moment, preparation for emergency cases. Keep copies of resources at work. Consider copying excerpts of important chapters, and collating them in a three ring binder. This practice makes important learning portable. Pick preparation materials that are most likely to help during any particular rotation. With the widespread access to computers in the patient care areas, literature searches can be done quickly and downloaded for later use. Proactive preparation is an effective tool against seemingly chaotic experiences as you develop strategies as a surgeon. In addition to patterning effective preparation practices you will proceed with determination, endurance and, equanimity. Preparation is the essential element for successful outcomes involving your patients.

Recommended Texts:

Atlas: Zollingers, Scott-Conner, Nora, Chassin
GI Texts: Maingot, Nyhus, Bell, Cameron

Patient Care and Management Skills

  • Develop skills and confidence as a leader of a surgical team.
  • Develop skills as a teacher of junior residents, students, patients and staff and provide a rewarding educational environment for them.
  • Develop skills as a trusted and helpful consultant of medical services.


Helpful Hints

As a consult you will be faced with challenging tasks. At the level of an R3, consultancy can become an additional drain of your time and energy. Done well, consults define the ultimate reward toward a surgical resident and culminating in cases well-done. Mishandled; consults can become a source of irritation and frustration. Communication with your referring physicians is vital to your survival as a surgeon. Remember, the internists ask for your help because, they have genuine concern for their patients. For instance, what you know to be an "obvious bowel obstruction” may appear as a "stomach flu" to novices. Now is the time to develop diplomatic skills reliant upon kindness and patience. These skills involving "emotional intelligence" will certainly benefit your practices as you progress in your career. Appreciate your knowledge and experience as you help with problems.

Administrative chores will be a challenge. Preparation of the weekly M report and presentation work for conferences will help you develop a quality of equanimity, or "grace under pressure" which is necessary. Organizational skills will, once again, be critical to minimize stress. Whatever your method for keeping track of your cases, make sure you keep data current and accurate.

As a leader, your attitude "plays in" heavily as you lead your team. Trying to get that crucial 110% out of your exhausted students and junior residents requires a superb demonstration-by-example. The right blend of knowledge, enthusiasm and humor will win them over and has the potential to turn a nightmarish rotation into an exhilarating learning experience. You will be the most important role model for 95% of your students. This is an amazing opportunity. They will always appreciate the one minute in ten that your attentive teaching provides. "Teaching moments" are an asset as an R3. You might just want to pull out that "Residents as Teachers" monograph by Whitman and peruse it occasionally.

Technical Skills

  • Breast cancer, open and laparoscopic cholecystectomy and others.
  • Develop the skill as a first assistant and teaching assistant within the operating room by proctoring junior residents on minor procedures such as wound closure and excisions.

Your technical skills will steer upwards within the learning curve this year. Don't be surprised if you feel like a klutz at times. Despite exhaustion, you will be expected to keep trying again and again.

Surgery looks easy, but there are many tricks which can help you learn faster. Ask your attendings for insights and practice basic moves. Utilize resources to help build good technical habits. Find a few discarded, disposable laparoscopic instruments, for instance, and use them to practice "tissue" handling, intracorporeal suturing and knot tying. Utilize the Surgical Education Labs to expedite your skills.

 

FOURTH YEAR


Rotations during R-4 year:

  1. General Surgery
  2. Vascular Surgery
  3. Trauma Surgery
  4. Pediatric Surgery
  5. Colon and Rectal Surgery
  6. Minimally Invasive Surgery

General Goals and Objectives

This is the last year for rotation on subspecialty services (pediatrics, trauma, colorectal, etc.). R4 is a "technical finishing school" where you will perform a large volume of technically demanding operations involving a more direct attending instruction in the OR. Furthermore, most R-4s are acting Chiefs on the services they rotate through, introducing them to leadership and administrative tasks.

Knowledge of Surgical Disease

  • Expand your knowledge of the scientific basis of surgery through reading and experiences
  • Survey, analyze and synthesize current surgical knowledge in the literature through, preparation of regular teaching conferences and the presentation of papers.

Rotations in the high case-volume private services at Christ provide a vast array of common general, endocrine and vascular surgical procedures that require review of the indications, technical aspects and outcomes expected from such operations. Preparation and presentation at M & M conference each week at Christ helps maintain an academic focus despite the high operative volume. Again, the surgical atlases and texts delineating procedures acquired in the R3 year should be well worn with use. Suggested additional resources appropriate at this stage are a good vascular text like Hamovici or Rutherford and a thoracic surgical text such as Sabiston and Spencer or Shield's General Thoracic Surgery.

Patient Care and Management Skills

  • Further refine your skills in leadership through close observation of attending surgeons.
  • Develop confidence in your management and operative skills by observing attendings in their roles.

As an "R4", you will assume a leadership role, and be called upon to make critical decisions while managing complex situations and honing skills in the OR. One word sums it up, "equanimity" which is the ability to "show grace" under pressure..

Another mark of a successful surgeon is good judgment.  It has been said that you learn good judgment from your mistakes made as a result of bad judgment. It has also been said a teacher protects his students from their own mistakes. Observe these qualities carefully among your mentors. Ask them questions such as, "How do you decide who does and who does not need an operation?" The master surgeon is not merely a professional who can sew the tiny blood vessel the fastest, but, he or she is also the person who knows which patient will benefit "most" from a given operation. Developing a sense of equanimity and concise judgments are the effective goals of the fourth year.

Technical Skills

  • Refine your technical skills through performance of a high volume, concentrated operative experience with attending supervision and guidance.

This year is a time for refinement of your technical skills through concentrated practice with experienced mentors who do a lot of technical operating. Listen carefully to their suggestions and watch them carefully. Make an effort to incorporate their advice into your repertoire. Be aware that there are many styles and ways of operating. No particular style is necessarily better than another but, it is "what works" for the individual surgeon. Stay flexible at this stage of your training. It is too early to become rigid in your style. Stubbornness will only hurt you in the eyes of your mentor. Some techniques that you learn in one discipline may not be generally transferable to all.

 

 

CHIEF YEAR


Rotations during R-5 year:

  1. General Surgery/Thoracic Surgery
  2. Vascular Surgery
  3. Trauma
  4. Surgical Oncology

General Goals and Objectives

This year is designed to give you the clinical independence, administrative responsibility, leadership and operative experience to prepare you for the practice of surgery..

Knowledge of Surgical Disease

  • Continue to build your knowledge of the science and practice of surgery by delving more into the literature behind the textbooks and verbal traditions that you have learned.
  • Review those areas which you feel have been overlooked in your training thus far, and read the textbooks--especially the chapters regarding the less frequently encountered clinical entities such as endocrine surgery, as well any basic science areas that may have been recently updated.

  • Prepare yourself for the business aspects of the practice of surgery through discussions with your attendings and faculty advisor.

You should continue to build your knowledge of the science and practice of surgery by delving more into the literature behind the textbooks and verbal traditions that you have learned. A healthy skepticism should motivate you to search the literature, on a continuing basis, regarding those problems that you encounter among your patients. In addition you should review those areas that may have been overlooked in your training, and read the textbooks. Pay particular attention to chapters addressing infrequently encountered clinical entities such as, endocrine surgery, as well any basic scientific material that may have been recently updated.

You should also learn as much as you can by observing the business and practice of surgery through discussions with your attendings and faculty advisor. Avoid the common pitfalls of a failed early practice regarded by some as the painful "fellowship in surgery practice." It is often too easy to remain in the OR and miss clinic, but you should also make a concerted effort to learn the principles and specifics of dealing with mundane, common outpatient entities and the vague issues that will fill your future office hours. It is not the hypotensive patient with the ruptured spleen that will give you the most trouble in the next few years, but more likely the ingrown toenails, hemorrhoids and vague mammograms. Pay keen attention and ask questions of your attending.

Patient Care and Management Skills

  • Develop your leadership skills through the running of the service, supervision of the junior residents and administrative duties as a chief.

  • Define your skills as a teacher through moderating conferences, holding teaching sessions and being a role model to the junior residents by assuring the educational atmosphere of daily rounds.

  • Establish yourself as a trusted consultant to the other medical services.

The Chief Resident year is intended to develop you as a leader. In most hospitals, as the most senior trainee you will be consulted for advice and guidance by all residents not just your own. You will be looked upon as a role model either good or bad. In this regard, it is always more effective to lead by example rather than by dictum. As in the OR, a sense of equanimity, or grace under pressure is vital. Punctuality and integrity are also essential for the smooth running of the service. Utilizing your skills as a teacher and your sense of humor, you will be able to lead the team into whatever battles are to be encountered, even if it is merely the continual fast pace and long hours inherent on a surgery service.

A professional demeanor and appearance is likewise important. You also have an administrative responsibility for the organization of call schedules, conferences, operative logs and assignment of cases pertaining to the next days' OR schedule. Conflict resolution between residents and ancillary staff will be your responsibility, especially after hours. These chores are not optional but a requirement of the training in general surgery; unlike other specialties where the chief residency is an optional year. Like most of the other aspects of your training this year is intended to be challenging to help you prepare for practice. When in doubt, consult your attendings and faculty advisor. You might want to re-read the "Chief Resident as Manager" by Whitman for tips. Although written intentionally for Chiefs in the primary care specialties, it has helpful tips that apply across the board to surgery.

Technical Skills

  • Develop skill in directing an operation when you are the primary surgeon.
  • Develop skill as a teaching assistant, taking junior residents through operations.
  • Further refine your technical skills and develop the techniques that work best for you.

Now that you have developed the basic technical skill of a surgeon you need to develop skill in directing the operation. It is one thing to "cut on the dotted line" as shown you by an experienced attending first-assisting you, and quite another to set up the exposure, retraction and think several steps ahead, all elements of a well conducted operation. Consideration of how to most effectively utilize the scrub and circulating nurses is also important so that you will have the exact thing needed at the time it is needed. In this year, you will often serve as the teaching assistant for junior residents, which will test your knowledge, organization and understanding of the operation. Again, your attendings are your best resource for this information. For many of them, these elements of an operation are nearly automatic and you will need to ask them to think out loud to help you develop the same degree of proficiency. As you become more proficient technically, consider the various styles of operative technique that you have experienced with various attendings and develop a sense of what works best for you. Keep in mind that there are "many ways to skin the cat" and that one style may be more appropriate than another in any given situation.

 

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