Program Description

Mayo Clinic in Jacksonville offers a five-year general surgery residency program. During your training in this program, your responsibilities will increase with your experience, capability and performance.

Throughout your residency, you will write all orders and be fully responsible for managing your patients. You will participate in rounds each morning as part of a resident/student/consultant team. During rounds new patients will be presented, inpatient management will be reviewed, and teaching sessions will be held. You also will make independent early morning and late afternoon rounds to review the results of tests and therapy, discuss progress with patients and their families, make further decisions, and write orders.

Faculty

In addition to caring for patients in their clinical practices, Mayo Clinic's faculty members are committed to teaching and facilitating the growth of medical knowledge. Our faculty members publish and present frequently and are recognized leaders in their fields. You will have direct access to these individuals throughout your training program.

Advisers
You will be assigned a faculty adviser who can provide comprehensive educational advice and personal support. Your adviser also will serve as a contact point, introducing you and your family to Jacksonville and the Mayo Clinic system.

Visiting Professors
Many prominent professors visit Mayo Clinic each year. They present their work during lectures and participate in hospital rounds and conferences. You are encouraged to take full advantage of these opportunities.

Curriculum

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

You will 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 will emphasize surgical technique and skill refinement. You will perform more complex operations such as gastrectomy, colectomy, aortic aneurysm repair, pneumonectomy, and hepatic and pancreatic resections.

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

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

Rotations
A brief description of each rotation is given below. All general surgery residency training takes place at Mayo Clinic in Jacksonville, except for Trauma/Burns (which takes place at Orlando Regional Medical Center in Orlando, Fla.) and Pediatric Surgery (which takes place at Wolfson's Children's Hospital Jacksonville, Fla). Mayo Clinic funds the authorized additional costs of travel, housing, and licensure fees for these rotations.

Abdominal Transplant Surgery (PGY-2)
As one of the five largest liver transplant programs in the country, you will have excellent exposure to the challenging and complex surgical and medical management of abdominal transplant patients. Time on the liver and kidney/pancreas transplant services are part of the curriculum. You will have the opportunity to go on organ retrievals, as well as serve as first assistant during the transplant.

Cardiothoracic and Cardiopulomnary Transplant 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 also part of the rotation.

Colorectal Surgery (PGY-1, 2, 3, 4, 5)
This service consists of up to two attendings: senior resident and junior resident. This is one of the busiest services, as one of the two surgeons is typically operating each day. You will be exposed to a variety of procedures, including all types of colon resection, transanal excision, and perianal problem management. This rotation will involve patient experiences with colon cancer, incontinence and inflammatory bowel disease. Experience with laparoscopic-assisted colon resection is also provided.

General Surgery (PGY-1, 2, 3, 4, 5)
The general surgery rotations are preceptorships, during which you will rotate with each staff member as the only resident on a particular service. You will operate with the consultant, run their clinic, and assume responsibility for managing all patient-care issues. Each consultant has a particular field of expertise upon which they base the majority of their practice. These interests include endocrine, laparoscopic and breast surgery.

Endocrine cases are comprised of thyroidectomy, standard and minimally invasive parathyroidectomy, and laproscopic and open adrenalectomy.

The 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 repairs, breast surgery, and gastric and small bowel resections.

Hepatobiliary Surgery (PGY-2, 3, 4, 5)
Provided through the abdominal transplant department, this rotation covers all aspects of hepatic, pancreatic and biliary tree surgery. You will learn advanced management of hepatobiliary cancers through clinical work-up, imaging, planning, treatment and postoperative care. Experience in hepatobiliary laparoscopic procedures is also part of the curriculum.

Intensive Care Unit/Anesthesia (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 two months as a PGY-2. You will 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 will include managing general surgery, abdominal and cardiopulmonary transplant, cardiothoracic, and medical patients. Extensive experience in infectious diseases, and ventilator and hemodynamic management of surgical and medical patients is provided.

The anesthesia rotation allows for experience in planning, airway management, induction, and intraoperative management of surgical patients across the spectrum of conscious sedation to cardiac and transplant anesthesia. Exposure to intraoperative transesophageal echocardiography is available. Pain management and advanced pain control techniques are also covered.

Pediatric Surgery (PGY-3)
This rotation takes place at Wolfson's Children's hospital in downtown Jacksonville, a busy primary/tertiary care facility. You will be 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 neonate, infant, and pediatric patients is also provided.

Subspecialties (PGY-1, 2, 3)
Gastroenterology - Includes extensive experience in esophagogastroduodenoscopy, colonoscopy and esophageal dilatation is provided. Exposure to endoscopic retrograde cholangiopancreatography, endoscopic ultrasound and photodynamic therapy is also available.
Gynecology - Experience is provided in laparoscopy, oncology and advanced uro-gyn procedures.
Neurosurgery - Spinal, intracranial and stereotactic neurosurgical procedures are covered.
Nutrition - Offer a two-week rotation in nutrition issues surrounding medical and surgical patients on the floor and in the ICU. A wide range of topics is covered, which includes management of short-gut patients.
Orthopedics - Provides exposure to joint replacement/reconstruction, hand, and oncologic procedures is provided. Ortho-pelvic surgery and pediatric orthopedics are also available.
Otorhinolaryngology - 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/Burns (PGY-2, 4)
Performed at the Orlando Regional Medical Center (ORMC) for two months during PGY-2 and three months during 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 will be provided. Experience in the admission and primary management of burn patients is provided at the PGY-2 level. During PGY-4, you will be chief of the trauma service and have your own surgical clinic. Extensive didactics are part of this rotation.

Orlando offers a large array of extracurricular activities, as well as easy access to the Kennedy Space Center and the Tampa Bay area. You are free to travel to Jacksonville on nights and weekends when off duty. Travel time is approximately 2 1/2 hours by car.

Vascular Surgery (PGY-1, 4, 5)
The Vascular service is managed by a PGY-4 or PGY-5, 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 Program. All residents are required to attend the sessions below:

• Morbidity and Mortality Conference (weekly)
• Surgical Basic Science Program (weekly)
• Surgical Grand Rounds (weekly)
• Tumor Board Conference (weekly)
• Consultant's Conference (bimonthly)
• GI Surg-Path Conference (bimonthly)
• Resident's Conference (bimonthly)
• Vascular Conference (bimonthly)
• Endocrine Surgery Conference (monthly)
• Journal Club (monthly)

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 will receive basic science instruction in topics such as wound healing, immunology, infections and organ system pathophysiology. You will be given a copy of the program reference text when you arrive at Mayo Clinic Jacksonville. An expert in the field being reviewed is invited to attend to supervise each session. Residents are required to generate questions based on the assigned reading for two sessions per academic year.

Surgical Grand Rounds Conference
Held once a week, this conference is given by both consultants and residents. Topics are chosen to be both educational reviews and presentation of advances in the current state of the art. Residents are expected to present two topics per academic year. Twice during the academic year, each PGY-4 and PGY-5 level resident presents a review of their surgical cases selected by the consultants as part of grand rounds.

Tumor Board Conference
Held weekly, this includes discussions of current medical and surgical oncology cases. Imaging, pathology and modes of treatment are discussed. Residents are expected to post and present cases as they become available.

Consultant's Conference
This conference is held bimonthly by a consultant in one of the various surgery departments on selected topics as they pertain to general surgery residents.

GI Surg Path Conference
This bimonthly 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. Residents are expected to present one case per year.

Resident's Conference
Held bimonthly, this conference is comprised of presentations of topics for general education chosen by the appointed resident. Items pertinent to board review are included.

Vascular Conference
A bimonthly conference that focuses on reviews and advancements in vascular surgery. Residents on the vascular surgery service are expected to present cases and/or topics selected by the consultants.

Endocrine Surgery Conference
This conference is held monthly and is teleconferenced to Mayo Clinic in Rochester and Mayo Clinic in Scottsdale. Cases are presented and reviewed by consultants who are experts in endocrinology and endocrine surgery. Residents are expected to present one case per year.

Journal Club
Held once per month, 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 or five articles at one journal club per academic year.

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.

You are encouraged to attend all regional and national general surgery meetings sponsored by Mayo Clinic.

Surgical Skills Workshops
During this workshop, you will receive specialized instruction in formal laboratory courses involving techniques and basic or advanced laparoscopic techniques. Workshops are held each month and residents rotate through in pairs.

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. Your program 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 will be 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 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 year 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 for incoming PGY-1s and re-certifying residents. Evening and weekend ACLS courses are also offered year-round through the department of continuing education. You must be certified in BCLS and ACLS before you begin your rotations and must maintain currency throughout your residency.

Case Studies
During your residency you will prepare case studies in which you will present the pertinent diagnostic information of an interesting case, conduct an in-depth discussion of that case and supply a current bibliography.

Teaching Opportunities
You will have the opportunity to teach Mayo Medical School students through bedside instruction and formal didactic lectures.

Resident Responsibilities
Your responsibilities will vary according to the specific rotation you are taking and your level of training. Your supervising faculty member will delegate and supervise all aspects of patient care, including diagnoses, preoperative, intra-operative 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.

In general, your responsibilities during the first year will emphasize inpatient services. The same is true for PGY-2, when you will have rotations in critical care medicine and general surgery services. Otherwise, you will participate in hospital inpatient activities and all outpatient services.

A unique aspect of Mayo Clinic's program is the institution's physician schedule, which alternates each day between operative and non-operative responsibilities. This scheduling permits surgical services to function as a team in the hospital and in the outpatient clinic. It also allows you to participate in the total care of patients under the supervision of a faculty member.

Call Frequency
Resident work hours and call schedules will be held in compliance with the Accreditation Council for Graduate Medical Education (ACGME) guidelines for resident work hours. In PGY-1 through 3 residents take in-house call while on general, hepatobiliary, plastics and vascular surgery rotations. Typically in-house call is every fifth or sixth night, with two weekends off per month. PGY-4 and PGY-5 level residents take home call rotated every third or fourth night and cover every third or fourth weekend. Subspecialty rotations are typically home call. All call in the intensive care unit and trauma/burns rotations is in-house.

Committee Assignments
You will be 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 will provide you with experience in administering the program, selecting and evaluating the curriculum, and determining resident rotations and call schedules.

Moonlighting
Moonlighting is permitted for licensed residents upon approval of the program director. Moonlighting may not interfere with a resident's duties or personal well being. Residents are responsible for all credentialing and liability associated with moonlighting.

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. You will be evaluated formally by your supervising faculty member after each clinical rotation. Each evaluation is reviewed carefully by the program director.

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.

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 Mayo Clinic's group practices.

Board Examinations
You will be required to take the written American Board of Surgery In-training Examination (ABSITE) each year. Your status in the program will not be determined solely by your ABSITE results, however a score greater than the 40th percentile is expected.

Oral In-Service Examinations
During PGY-4 and PGY-5 of training, you will participate in oral in-service examinations given by Mayo staff members. These "mock" exams will prepare you for the certifying examination of the American Board of Surgery (ABS). Half-hour interviews will be conducted in a format similar to that used by the ABS.

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 will provide this training at one of the Regional Centers.

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 (RRC) for Surgery of the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Surgery (ABS).

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 are in private practice. These graduates are practicing in 22 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 offers fellowship programs that complement the general surgery residency program:

• Aesthetic and Reconstructive Surgery
• Cardiovascular Surgery
• Colon and Rectal Surgery
• Cardiopulmonary Transplantation
• Surgical Critical Care Surgery
• Gastrointestinal Surgery
• General Thoracic Surgery
• Multidisciplinary Breast 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.

Admissions

Qualifications
Appointments for Mayo Clinic's preliminary surgery residency are made through the National Residency Matching Program (NRMP).

Application Process

Positions
Mayo Clinic in Jacksonville offers two categorical general surgery positions at the PGY-1 level each year on a competitive basis.

Application
To apply to Mayo Clinic's General Surgery Residency, you must to submit an electronic application via the Electronic Residency Application Service (ERAS) through your medical school dean's office.

To use this application process, you'll need the following information:

• Official college, graduate school, and medical school transcripts
• Official test transcripts for all applicable examinations (USMLE, LMCC, COMLEX, NBOME, FMGEMS, FLEX or NBME)
• A dean's letter and two other letters of recommendation
• A curriculum vitae
• A personal statement
• A valid ECFMG certificate (if you graduated from medical school outside of the United States or Canada)

Foreign medical graduates should contact the ECFMG for information and instructions on how to apply using ERAS.

Applications for each academic year, which begins in July, should be completed by November 1 of each year.

If you are considered for an appointment, you will be asked to visit Mayo Clinic in Jacksonville for an interview with the program director and selected faculty.

Interviews are conducted from November through January each year.

Program Contacts

If you like more information about the general surgery training programs at Mayo Clinic in Jacksonville, please contact:

C. Daniel Smith, M.D.
General Surgery Residency Program Director

Melissa Bishop
General Surgery Residency Coordinator
(904) 953-0423
bishop.melissa@mayo.edu

Mayo Clinic College of Medicine
Graduate Education
4500 San Pablo Road
Jacksonville, FL 32224

For more information about Mayo Clinic residencies and fellowships, please contact:

Mayo Clinic College of Medicine
Mayo School of Graduate Medical Education
200 First Street S.W.
Rochester, MN 55905
(507) 284-2220