Ascension St. John Hospital Years I and II

The first year of training is designed for physicians who have just graduated from medical school and consists of:

• General Surgery — 6 months
• Plastic Surgery — 1 month
• Subspecialty Elective — 1 month
• SICU — 1 month
• Vascular — 2 months
• Trauma Surgery — 1 month

The first year of training is designed to provide new surgeons with a broad perspective for total care of the surgical patient as well as an overall view of the Surgical Department and its relationship with other closely allied services at Ascension St. John Hospital. Grad Year I physicians are expected to develop a knowledge of surgical disease through bedside and operative experience. During this year, they assist at operations performed on patients on their services, during which time they learn to recognize surgical pathology. In major cases, regional anatomy will also be emphasized, and they will undertake to master basic surgical technique. Under the supervision of the staff, they may perform procedures such as hernia repair, laparoscopic cholecystectomy, breast surgery and a wide variety of other operative procedures. The surgical residents at Ascension St. John Hospital find that they intimately participate in more operative cases and are exposed to more diverse and advanced cases than most of their classmates from medical school who are training at other surgical programs. The hands-on concept is emphasized early during the first year. First year residents also share the responsibility of surgical floor care. Residents watch over the seriously ill. They are taught to be alert to changes in the course of the disease involved and attend to the vital knowledge of intake and output, fluid balance, and pre- and post-operative care, etc. It is at this level of training that they learn, at the bedside, the fundamentals of fluid balance, physiology, bacteriology, pharmacology and other basic sciences which are necessary for the total understanding of the disease process. Acute trauma, vascular insufficiency, TIA ruptured aneurysms, strokes, coma, level of consciousness, neoplasms, etc. are all items of required surgical knowlege.

In addition to six months of exposure to General Surgery, the first year resident rotates through Plastic Surgery, a Subspecialty Elective, the Surgical Intensive Care Unit, Vascular Surgery, Trauma. During the rotation in plastic surgery, particular emphasis will be placed on wound healing, skin grafting, incision location for optimum cosmetic results, management of trauma, particularly facial trauma, etc. The Subspecialty Elective allows a first year resident to explore ENT, urology, orthopedics, neurosurgery or a combination of these during the one month rotation. This allows for some flexibility for the resident to choose from a number of educational experiences. Residents will rotate through the Surgical Intensive Care Units during their first year. The performance and efficiency of the Surgical Intensive Care Unit at Ascension St. John Hospital is outstanding. The residents' training and responsibilities are such as to enhance their knowledge of pulmonary, cardiac and renal pathophysiology. Their experience in the Surgical Intensive Care Unit will be extensive and extremely rewarding. The Vascular Service will expose the first year resident to thrombo-occlusive disorders, aneurysmal disease, venous problems and lymphatic disorders. Clinical diagnosies and vasclar surgical principles are emphasized. The use of endovascular stents, open surgical procedures and dialysis access is extensive allowing for many hands-on opportunities to become proficient in technical skills. The residents will see trauma throughout their entire five-year residency when on call, but will have focused trauma training during their Trauma Service rotations beginning in their first year of training. This service integrates a team consisting of a Trauma Surgeon, a third-year surgical resident, a first-year surgical resident, a trauma nurse practitioner, a trauma registrar, a social worker, pharmacy staff, subspecialty physicians, and an emergency department resident. Daily trauma teaching rounds and numerous trauma lectures educate the residents during this valuable rotation in managing the critically injured patient.

Residents will participate in all surgical conferences, preparing the protocol of the patients to be discussed. At teaching rounds, residents are expected to have thorough knowledge of each patient's history, physical examination, laboratory studies and clinical course.