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Curriculum

Clinical training

Photo of Mayo resident in the simulation center

Preoperative and postoperative care is stressed at the junior level (PGY-1 and PGY-2). During PGY-2, you also serve as a senior resident in the intensive care unit. Your training emphasizes basic science knowledge and the development of basic surgical skills.

You begin your operative experience with common general surgery procedures. On average, junior-level residents operate every other day; typical procedures include mastectomy, cholecystectomy, appendectomy and herniorrhaphy.

At the PGY-3 and PGY-4 levels, your training emphasizes surgical technique and skill refinement. You perform more complex operations such as gastrectomy, colectomy, aortic aneurysm repair, pneumonectomy, and hepatic and pancreatic resections.

At the PGY-5 level, you gain experience in the entire spectrum of straightforward and complex general surgical problems. You manage your service and all patient responsibilities and manage and teach junior-level residents and medical students.

Rotation schedule

PGY-1

Rotation Length
Colorectal surgery 2 months
General surgery 3 months
Intensive care unit 1 month
Surgical oncology 2 months
Hepatobiliary surgery 2 months
Vascular surgery 2 months

PGY-2

Rotation Length
Abdominal transplant surgery 2 months
Colorectal surgery 1 month
Gastroenterology 1 month
Ear-nose-throat 2 months
General surgery 1 month
Hepatobiliary Surgery 1 month
Intensive care unit 1 month
Trauma/burns 2 months
Vascular surgery 1 month

PGY-3

Rotation Length
Cardiothoracic surgery 1 month
Colorectal surgery 2 months
Surgical oncology 2 months
Elective 1 month
Hepatobiliary surgery 2 months
Pediatric surgery 2 months
Plastic surgery 1 month
Vascular surgery 1 month

PGY-4

Rotation Length
Hepatobiliary surgery 2 months
Colorectal surgery 1 months
Trauma/burns 2 months
Vascular surgery 3 months
Surgical oncology 2 months
General surgery 2 months

PGY-5

Rotation Length
Colorectal surgery 2 months
General surgery 4 months
Vascular surgery 2 months
Hepatobiliary surgery 2 months
Surgical oncology 2 months

Rotation descriptions

Photo of Mayo resident in the simulation center

All general surgery residency training takes place at Mayo Clinic in Florida, except for trauma and burns (which takes place at the University of Florida College of Medicine-Jacksonville) and pediatric surgery (which takes place at Nemours Children's Clinic, part of Wolfson Children's Hospital in Jacksonville, Fla.).

Abdominal transplant surgery (PGY-2)

As one of the five largest liver transplant programs in the country, Mayo Clinic provides excellent exposure to the challenging and complex surgical and medical management of abdominal transplant patients. Time on the liver and kidney-pancreas transplant services is part of the curriculum.

You have the opportunity to experience both organ retrieval and procurement as well as assist during the transplant. You follow these patients after transplant and are educated on the immunosuppressive practices.

Cardiothoracic surgery (PGY-3)

Extensive cardiothoracic and cardiopulmonary transplant experience is available during this rotation. Active involvement in general thoracic and video-aided thoracoscopic surgery is provided. You are also able to participate as first assistant in many cardiac cases. Involvement in organ retrieval and transplant is part of the rotation.

Colorectal surgery (PGY-1, -2, -3, -4, -5)

This service consists of up to three attendings (senior resident and junior resident). This is one of the busiest services, as one of the three surgeons is typically operating each day. You are exposed to a variety of procedures, including all types of colon resection, transanal excision and perianal problem management. This rotation involves patient experiences with colon cancer, incontinence and inflammatory bowel disease. Experience with laparoscopic colon resection is a key part of the experience.

General surgery (PGY-1, -2, -3, -4, -5)

The general surgery rotations are apprenticeships during which you rotate with each staff member as the only junior or senior resident on a particular service. You operate with the consultant, run his or her clinic, and assume responsibility for managing all patient care issues. Consultants have a particular field of expertise upon which they base the majority of their practice. These interests include endocrine, laparoscopy, foregut, hernia, gastrointestinal motility and reflux.

Endocrine cases are composed of thyroidectomy, standard and minimally invasive parathyroidectomy, and laparoscopic and open adrenalectomy. Laparoscopic cases include Nissen and Toupet fundoplication, splenectomy, cholecystectomy, appendectomy, and esophageal myotomy.

In addition to these specialty cases, the general surgery department performs a large amount of basic general surgical procedures, including hernia repair and gastric and small bowel resections.

Hepatobiliary surgery (PGY-2, -3, -4, -5)

This rotation covers all aspects of hepatic, pancreatic and biliary tree surgery. We have two dedicated hepatobiliary surgeons who each perform a large number of pancreatic and biliary cases. You learn advanced management of hepatobiliary cancers through clinical work-up, imaging, planning, treatment and postoperative care. Experience in hepatobiliary laparoscopic procedures is a key part of the curriculum.

Intensive care unit (PGY-1, -2)

The intensive care unit is currently a combined medical-surgical unit. The experience consists of one month as a PGY-1 and one month as a PGY-2. You have a large amount of autonomy in patient management. At the PGY-1 level, you work with a senior resident or fellow when on call. At the PGY-2 level, you act as a senior resident when on call.

Your responsibilities include managing general surgery, abdominal and cardiopulmonary transplant, and cardiothoracic and medical patients. Extensive experience in infectious diseases and ventilator and hemodynamic management of surgical and medical patients is provided. You also have opportunities to perform procedures such as central venous line placement, tracheal intubation, percutaneous tracheostomy and percutaneous gastrostomy procedures.

Pediatric surgery (PGY-3)

This rotation takes place at Wolfson Children's Hospital in downtown Jacksonville, a busy primary and tertiary care facility. You are exposed to the surgical management of pediatric patients on the floor and in the pediatric and neonatal intensive care units.

Emergency room consults, as well as basic and advanced procedures, are part of the rotation. Exposure to advanced pediatric laparoscopic procedures in neonatal, infant and pediatric patients also is provided.

Subspecialties (PGY-1, -2, -3)

  • Gastroenterology. Extensive experience in esophagogastroduodenoscopy, colonoscopy and esophageal dilatation is provided. Exposure to endoscopic retrograde cholangiopancreatography, endoscopic ultrasound and photodynamic therapy also is available.
  • Otorhinolaryngology. This includes cases involving microsurgery and extensive neck dissection.
  • Plastic surgery. Reconstruction and closure of complex wounds and cosmetic reconstructive procedures and postoperative management are taught in both inpatient and outpatient surgical environments.

Trauma and burns (PGY-2, -4)

Performed at the University of Florida College of Medicine-Jacksonville for two months during PGY-2 and PGY-4, this rotation provides a full spectrum of emergency room and trauma care experience.

Exposure to penetrating and blunt trauma management of both adult and pediatric patients is provided. Experience in the admission and primary management of burn patients is provided at the PGY-2 level. During PGY-4, you are chief of the trauma service and have your own surgical clinic. Extensive didactics are part of this rotation.

Vascular surgery (PGY-1, -3, -4, -5)

The vascular service is managed by a PGY-3, -4 or -5 resident and a PGY-1 resident. The senior resident is responsible for supervising all aspects of patient management, and both residents participate in operating room activities. There is a wide variety of cases, including procedures in endovascular and open abdominal aortic aneurysm repairs, mesenteric revascularization, carotid endarterectomy, vascular bypass, and vascular access.

Didactic training

Clinical conferences, seminars, small discussion groups, journal clubs, and one-on-one instruction are an integral part of Mayo Clinic's General Surgery Residency. All residents are required to attend these sessions:

  • Morbidity and Mortality Conference (weekly)
  • Surgical Basic Science Program (weekly)
  • Surgical Grand Rounds (weekly)
  • Gastroenterology and Surgery Conference (monthly)
  • Journal Club (monthly)
  • Simulation Center (twice monthly)

Research training

Research opportunities at Mayo Clinic are outstanding. Your particular project(s) depend on your interests and background. Research opportunities are divided into two broad categories: clinical and basic science laboratory research. Several faculty members have robust research databases and continuously active projects.

Clinical research

You have access to Mayo Clinic's world-renowned medical records system for clinical research. During your residency, you conduct at least one clinical research project, publish the results, and make at least one regional or national presentation. The program director and associate director can assist you in the selection of a topic or assign you a mentor based on your particular interests.

Basic science laboratory research

If you have an excellent clinical record and are interested in an academic surgical career, you are encouraged to pursue basic science laboratory research. Credits can be applied toward a master's or Ph.D. at Mayo Graduate School.

Mayo Clinic offers two basic science laboratory research opportunities: a one-year research program and a two-year Clinician-Investigator Program.

One-year research program

This program gives you the opportunity to assess your aptitude for bench research and develop your fundamental research skills. To enhance your productivity, you are encouraged to initially base your research on an existing research project. Current areas of basic science laboratory research include:

  • Cardiac surgery
  • Colorectal physiology
  • Gastrointestinal physiology
  • General thoracic surgery
  • Laparoscopic surgery
  • Oncology and immunology
  • Pediatric surgery
  • Plastic surgery
  • Transplantation
    • Xenotransplantation
    • Cardiac and lung
    • Hepatic
    • Renal and pancreas
  • Vascular surgery

Clinician-Investigator Program

Mayo Clinic's Clinician-Investigator Program is two years long. When you complete this program, you are academically prepared, competent in clinical surgery, technically skilled in research and capable of competing in today's research environment.

The Clinician-Investigator Program includes two years in basic science laboratory research and a core curriculum of research seminars, guest seminars and didactic courses in subjects such as:

  • Advances in cell molecular biology
  • Cellular and quantitative biology
  • Physiology
  • Statistics

If you are interested in the Clinician-Investigator Program, you should indicate your interest early in your residency training. You are then assigned to a faculty member who helps you develop a competitive written research proposal.

Call frequency

Resident work hours and call schedules are held in compliance with the Accreditation Council for Graduate Medical Education (ACGME) guidelines for resident work hours. These guidelines are listed under the program requirements. Our interns fulfill call duties through a night float system. Each intern covers one week of nights at a time with all weeks evenly distributed.

Teaching opportunities

You have the opportunity to teach Mayo Medical School students, visiting medical students and midlevel provider students (physician assistants) through bedside instruction and formal didactic lectures.

Conferences

  • Morbidity and Mortality Conference. This weekly conference reviews cases of interest for faculty review and resident education concerning problems in patient management. All residents are expected to participate in case presentation and review.
  • Surgical Basic Science Program. You receive basic science instruction in topics such as wound healing, immunology, infections and organ system pathophysiology. You are given a copy of the program reference text when you arrive at Mayo Clinic in Florida. An expert teaching physician in the field being reviewed is invited to attend to supervise each session and give a didactic lecture in addition to the teaching performed by the senior residents. Additional educational lectures may be distributed among the junior residents.
  • Surgical Grand Rounds. Held once a week, this conference is given by consultants and visiting professors. Topics are chosen to be both educational reviews and presentations of advances in the current state of the art. Visiting professors are invited to give Grand Rounds at least five times annually.
  • Gastroenterology and Surgery Conference. This monthly conference is a combined interaction between the surgery, gastroenterology, radiology and pathology departments. Cases with pertinent teaching points and review of the current literature are presented. Surgery residents and gastroenterology fellows are expected to present one case a year in association with a surgery and gastroenterology attending physician. A list of key topics is maintained to ensure all pertinent topics are covered.
  • Journal Club. Held quarterly, Journal Club covers articles from the current literature, which are selected by the consultant and resident for critical review. Each resident is expected to present four articles at one Journal Club per academic year. Journal Clubs are held at attending physicians' homes.

During each subspecialty rotation, you also attend that subspecialty's weekly schedule of journal clubs, didactic presentations and multidisciplinary conferences dealing with patient management problems.

J. Wayne and Delores Barr Weaver Simulation Center

The Mayo Clinic in Florida campus recognizes the increasingly vital role that simulation plays in surgical education. In order to accommodate the needs of our residents, the brand-new 9,000-square-foot simulation center was established in January 2013 with the help of a generous donation by J. Wayne and Delores Barr Weaver. The simulation center boasts high-fidelity skills trainers and simulation rooms for a wide variety of surgical tasks and scenario simulation.

Junior residents participate in a structured curriculum that is proctored by faculty from each surgical discipline. Training is provided for basic skills such as suturing and knot-tying as well as more advanced laparoscopy, endoscopy, robotic surgery and simulated endovascular interventions.

The curriculum is designed to supplement, but not replace, technical training in the operating room setting. We believe that simulation of sound fundamental skills is an integral part of resident education. Our faculty adviser for the simulation center is John A. Stauffer, M.D.

Resident responsibilities

Your responsibilities vary according to the specific rotation and your level of training. Your supervising faculty member delegates and supervises all aspects of patient care, including diagnoses; preoperative, intraoperative and postoperative care; and subsequent outpatient follow-up.

Continuity of care

Continuity of care is extremely important for both the patient's well-being and for resident education. Work rounds are held on all services at least twice a day; teaching rounds are conducted with the supervising faculty daily.

A unique aspect of Mayo Clinic's program is the institution's physician schedule. Physicians are paired on working teams and operate on opposing days. This scheduling permits surgical services to function as a team in both the hospital and outpatient clinic. It also allows you to participate in the total care of patients under the supervision of a faculty member.

Committee assignments

You are given an opportunity to gain experience in a number of administrative capacities during your residency. For example, appointment to the general surgery residency education committee provides you with experience in administering the program, selecting and evaluating the curriculum, and determining resident rotations and call schedules.

Career development

You meet periodically with various faculty members, administrators and the training program director to discuss your individual career goals. Mayo Clinic recruits many of its staff physicians from its own training programs, so when you successfully complete your general surgery training, job opportunities may be available at one of Mayo Clinic's group practices.

Board examinations

You are required to take the written American Board of Surgery In-Training Examination (ABSITE) each year. Your status in the program is not determined solely by your ABSITE results. However, these scores are a direct reflection of future success on the qualifying (written) board exam. A score greater than the 40th percentile is strongly encouraged.

Oral in-service examinations

During PGY-3, -4 and -5, you participate in oral in-service examinations given by Mayo staff members. These mock exams prepare you for the certifying examination of the American Board of Surgery. Half-hour interviews are conducted in a format similar to that used by the American Board of Surgery. At the completion of the exam, residents are given constructive feedback on skills for improvement.

Advanced Trauma Life Support certification

You are required to become certified in the American College of Surgeons' Advanced Trauma Life Support program. If you have not completed this course prior to entry into the program, we provide this training at one of the regional centers.

Operative experience

The operative experience of residents completing Mayo Clinic's General Surgery Residency is well within the guidelines of both the Residency Review Committee for Surgery of the ACGME and the American Board of Surgery. In 2012, the Mayo Clinic in Florida program received the maximum certification of five years.

Present professional status

Of the physicians who graduated from Mayo Clinic's general surgery programs in the past eight years, 60 percent pursued additional fellowship training. Academic appointments are held by 33 percent of the graduates, and the remaining graduates are in private practice. These graduates are practicing in 22 states.

Additional training

After you successfully complete Mayo Clinic's General Surgery Residency, you are highly competitive for fellowship training programs at Mayo Clinic and throughout the U.S.

Mayo Clinic offers fellowship programs that complement the General Surgery Residency. These fellowships offer in-depth, daily, one-on-one training with a consultant and the opportunity to increase your surgical, supervisory and administrative skills. During your residency, you can talk with your faculty adviser about these opportunities:

Evaluation

To ensure you gain proficiency and develop the corresponding technical skills, your performance is monitored throughout this program. You are formally evaluated by your supervising faculty member following the completion of each clinical rotation and then meet with the program director to review these evaluations. In addition, you regularly evaluate the faculty to ensure your educational goals are being met.

  • Sep 26, 2013
  • ART899324