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Curriculum

While intern and PGY-2 residents operate every other day like their senior resident colleagues, training in years PGY-1 and PGY-2 is weighted to pre-operative and post-operative patient care. Intern rotations include Trauma Critical Care General Surgery (TCGS), Orthopedics, Vascular & Plastic Surgery, and rotations with General Surgery staff & chief residents. In PGY-2, you will serve as the senior resident in the surgical intensive care unit and have rotations in Pediatric Surgery, Anesthesiology, Endoscopy, Gynecologic, Colorectal and General Surgery. Five weeks of elective time is often used to experience Cardiac, General, or other subspecialty surgery areas. During PGY-3 and PGY-4, your training will emphasize surgical technique and skill refinement with rotations including Transplantation, Vascular, Thoracic, Colorectal, Endocrine, and Hepatobiliary surgery. PGY-4s lead our TCGS team to care for critically injured patients coming to Mayo from throughout the Midwest. As a chief resident in PGY-5, you will lead your own surgical team and assume full responsibility for patient and resident team management.

Clinical Training
The specific rotations for the five-year program are shown below.

PGY-1 Rotations Length
Trauma, Critical Care and General Surgery (TCCGS) 3 months
General Surgery 5 months
Vascular Surgery 1.5 months
Orthopedic Surgery 1 month
Plastic Surgery 1.5 months
PGY-2 Rotations Length
General Surgery 4 months
Surgical Critical Care (TCCGS) 3 months
Colon and Rectal Surgery 1.5 months
Endoscopy/Anesthesia/ Elective 1.5 months
Gynecologic Surgery 1 month
Pediatric Surgery 1 month
PGY-3 Rotations Length
General Surgery 5 months
Pediatric Surgery 3 months
Transplant Surgery 1 months
Thoracic Surgery 3 months
PGY-4 Rotations Length
General Surgery 3 months
Colon and Rectal Surgery 1.5 months
Vascular Surgery 3 months
TCCGS 4.5 months
PGY-5 (Chief Resident) Rotations Length
General Surgery 7.5 months
Vascular Surgery 3 months
Colon and Rectal Surgery 1.5 months

During PGY-3 you may elect to spend six weeks at one of two off-site rotations: Managing pediatric surgical patients at the St. Paul Children's Hospital in St. Paul, Minn., or caring for general surgery patients at the Skemp Clinic in La Crosse, WI. Both sites reside an hour from Rochester by car and harbor numerous busy surgeons (St.Paul = 8, La Crosse = 4) in a friendly environment void of other residents or fellows. Mayo Clinic funds the authorized additional costs of housing and licensure fees for these rotations. Our residents consistently rate these rotations as highly educational.

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 Program. All residents are required to attend our weekly morbidity and mortality conferences and Monday evening Grand Rounds. Friday morning sessions are held every other week in both simulation and surgical skills centers to enhance resident learning.

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

You are encouraged to attend regional or national general surgery meetings sponsored by Mayo Clinic, and most residents attend the Minnesota Surgical Society meeting one or more times in the five-year period.

Surgical Basic Science Program
You will receive basic science instruction in topics such as wound healing, immunology, infections and organ system pathophysiology. All residents are expected to attend this weekly session held on Monday afternoons before the chief resident conference.

Trauma, Critical Care and General Surgery
Your PGY-1 TCCGS rotation will include a formal lectures as well as daily informal sessions on any number of topics in trauma and critical care. Ten Mayo TCGS staff (boarded in both critical care and general surgery) actively participate in educating residents and students about all facets of trauma and critical care.

Surgical Critical Care Program
During PGY-1 and PGY-2, your surgical critical care rotations will include daily learning about the fundamentals of critical care management. Mayo Clinic has a high volume of tertiary care patients, so you will have broad exposure to nearly all aspects of critical care. Additional senior level rotations in cardiothoracic, vascular, pediatric and general surgery allow residents to mature their ICU skills and care over the ensuing three years.

During PGY-2 and PGY-3, you will meet monthly throughout the academic year for journal club. You will learn how to critically analyze and interpret scientific articles.

Advanced Trauma Life Support Certification
As an intern, you will have the opportunity to become certified in the American College of Surgeons' Advanced Trauma Life Support program. A re-certification course is offered during PGY-3.

Professional Conferences
In addition to clinical experience, didactic training and special courses, Mayo Clinic offers a wide variety of professional conferences and on-line learning. Whether as part of JCAHO regulations or Mayo Clinic Graduate School of Medicine recommendations, dozens of on-line modules teach current best practices for infectious diseases, professionalism, recordkeeping, etc.

The main department teaching conference is weekly general surgery Grand Rounds. This is a common meeting ground for all of the subspecialties within the department. Attending consultants openly critique case presentations by chief residents who are assigned to the general surgery, vascular surgery, and colon and rectal surgery services. Additionally, senior-level residents in pediatric, thoracic, transplant, TCCGS present their operative lists for scrutiny and education. After discussing the management issues involving patients on such services, staff members make a formal didactic presentation on an area of their expertise
Monthly video teleconferences with staff and residents from sister Mayo Clinic sites in Scottsdale, AZ and Jacksonville, FL in general, endocrine and vascular surgery provide education for staff and residents about diverse and difficult surgical problems in a high-tech environment.

Additional conferences, which include staff pathologists and radiologists, are held monthly to educate surgical residents in managing all facets of patient care: pre-, intra- and post-operative lessons will be taught.

Research Training
Research opportunities at Mayo Clinic are outstanding. Your particular project(s) will depend on your interests and background. Research opportunities are divided into two broad categories: Clinical and basic science laboratory research.

Clinical Research
You will have access to Mayo Clinic's world-renowned medical records system for clinical research. During your residency, you will conduct at least one clinical research project, publish the results, and make at least one regional or national presentation.

Basic Science Laboratory Research
If you have an excellent clinical record and are interested in an academic surgical career, you will be encouraged to pursue basic science laboratory research. You may begin a research project after PGY-2, or you may complete your residency training and then focus on research. Roughly one-third of our general surgery residents add one or more years of laboratory research to their five-year residency training. Credits can be applied toward a M.S. or Ph.D. at Mayo Graduate School.

Mayo Clinic offers two basic science laboratory research opportunities: A one-year program and a two-year clinician-investigator program.

One-Year Research Program
This program will give 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/Immunology
  • Pediatric Surgery
  • Plastic Surgery
  • Transplantation
    • Xenotransplantation
    • Cardiac/Lung
    • Hepatic
    • Renal/Pancreas
  • Vascular Surgery

Clinician-Investigator Program
Mayo Clinic's Clinician-Investigator Program is two years in length. When you complete this program, you will be 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 will then be assigned to a faculty member who will help you develop a competitive written research proposal.

Certification
You are required to become certified in Basic Cardiac Life Support (BCLS) and Advanced Cardiac Life Support (ACLS). ACLS courses are held during the last week of June, just before the start of the academic year. An evening ACLS course also is offered every three months to facilitate re-certification. You must be certified in BCLS and ACLS before you begin your TCCGS rotations.

Case Studies
During your residency you will frequently prepare case study presentations. You will present pertinent information from an interesting case, conduct an in-depth discussion of that case, using evidence-based material.

During your residency you will frequently prepare case study presentations. You will present pertinent information from an interesting case and conduct an in-depth discussion of that case, using evidence-based material.

In-Training Examinations
Each year you will take the written American Board of Surgery In-Service Training Examination (ABSITE). During PGY-4 and PGY-5, you will participate in oral clinical examinations given by Mayo Clinic's surgical staff. These mock oral exams use the same format as the oral certification examination given by the American Board of Surgery.

Teaching Opportunities
You will have the opportunity to supervise and teach Mayo Medical School students and visiting student clerks through bedside instruction, operative interaction, and formal didactic lectures.

Committee Assignments
You will be given an opportunity to gain experience in a number of administrative capacities during your training. Class representatives meet with the General Surgery Residency Committee each month to improve the surgical program. Additional committees led by residents focus on improving all facets of resident training from camaraderie to laparoscopy to robotic experiences.

Moonlighting
Moonlighting is permitted for licensed residents only when you do not have clinical responsibilities (e.g., during research time or while you are on vacation).

Evaluation
To ensure that you acquire adequate knowledge and develop your technical skills, your performance will be monitored carefully during the course of your general surgery training. Your supervising faculty member will formally evaluate you after each clinical rotation. Each evaluation is reviewed carefully by the program director. Electronic access allows you to develop a portfolio of evaluations, curriculum vitae, educational competence, and academic effort that will be yours on graduation.

Annual reviews of each resident at our General Surgery Residency Committee meetings occurs, and your performance in all aspects of surgery must be satisfactory at each level of training before you will be promoted to more advanced levels. Mayo goes to great length to help struggling trainees improve their performance and a track record of graduating chief residents successful in fellowships or private practice is testimony to a wonderful system of learning.

In addition, you will regularly evaluate the faculty and our program to ensure that your educational needs are met.

Career Development
You will 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. Thus, when you successfully complete your general surgery training, job opportunities may be available at one of the Mayo Clinic group practices.

Graduate Outcomes
The most important sign of the success of any training program is how its graduates fare after they begin their careers. Every resident who successfully completed Mayo Clinic's General Surgery Residency Program has been eligible for American Board of Surgery certification.

During the past five years, 98 percent of residents successfully passed the American Board of Surgery qualifying (written) examination and 97 percent passed the certifying (oral) examination on their first attempt. The overall success rate of Mayo graduates in obtaining ABS certification is 98 percent.

Operative Experience
The operative experience of residents completing Mayo Clinic's General Surgery Residency Program is well within the guidelines of both the Residency Review Committee for Surgery of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery. For example, the average total numbers for ten residents who finished the General Surgery Residency Program in 2008 were:

Major Operations
As Chief Resident 228 operations
As Junior Surgeon 793 operations
As Teaching Assistant 16 operations
Total Operations 1,037 operations

Present Professional Status
Of the physicians who graduated from Mayo Clinic's General Surgery Residency Program in the past eight years, 72 percent pursued additional fellowship training.

Academic appointments are held by 33 percent of recent graduates while the remaining are in private practice. These graduates are practicing in 22 different states.

Additional Training
After you successfully complete Mayo Clinic's General Surgery Residency Program, you will be highly competitive for fellowship training programs at Mayo Clinic and throughout the United States.

Mayo Clinic in Rochester offers fellowship programs that complement the General Surgery Residency Program.

  • Adult Cardiac Surgery
  • Minimally Invasive Breast Surgery
  • Cardiovascular/Thoracic Surgery
  • Colon and Rectal Surgery
  • Congenital Cardiac Surgery
  • Critical Care Surgery
  • Endocrine Surgery
  • Gastrointestinal Surgery
  • General Thoracic Surgery
  • Minimally Invasive Surgery
  • Plastic Surgery
  • Transplantation Surgery
  • Vascular Surgery

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.

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