General Surgery Clinical Experience
Residency education in general surgery at the University of Alabama at Birmingham is comprised of five clinical years. Seven categorical residents are accepted into the program annually through the National Residency Matching Program. Residents have the option to complete two years of research, free of clinical duties, after their second or third year of clinical training. All house officers receive extensive training in preoperative evaluation in the clinic and hospital settings, intraoperative technique, postoperative and critical care management, and follow-up care. Surgical residents train at four hospitals located within the downtown medical center - University, VA, county (Cooper Green Hospital), and Children's hospitals.
The first year categorical residents (PGY 1) rotate through four hospitals and share junior resident duties with first year residents from the other surgical disciplines. Duties include initial evaluation and treatment of patients, participating in rounds and conferences, attending clinics, operating on level-appropriate cases in the operating room, and acting as teachers and mentors to medical students on their surgical clerkships. The first year provides house officers with a very broad training in one-month rotations. First year residents are given much responsibility for the care of the ward patient. Upon completion of the first year, residents are very comfortable dealing with pre- and postoperative patient issues. The average resident will log 100 major cases during his/her first year. Surgical oncology, gastrointestinal surgery, pediatric surgery, and the county hospital offer junior residents the greatest breadth of operative exposure. All call is in-house during the first year. Vascular, gastrointestinal, renal/liver transplant, and oncology first year resident call is covered during the week by a night float resident. Two first year and one second year residents comprise the night float team. For these aforementioned four services, the first year resident on service will take call one night, every other weekend. Pediatric surgery call is general every fourth night and the county hospital call is every third night. Trauma call is normally every fifth or sixth night.
During the second post-graduate year (PGY 2), residents gain an increasing amount of clinical independence and responsibility for the critically ill patient. Seven to eight week rotations during the second year include surgical oncology, gastrointestinal, endoscopic, cardiovascular, and vascular (night float) surgery, as well as rotations on the trauma/burns and surgical intensive care units. Second year residents gain increased exposure to laparoscopy and more complex cases. During the resident's endoscopy rotation, he/she has the option to participate in any and all colonoscopies, flexible sigmoidoscopies, EGD's, and PEG's done by the gastrointestinal staff. In-house call varies from every fourteenth night on gastrointestinal surgery and surgical oncology (covered by night float) to every third or fourth night in the intensive care units. One rotation is spent as the vascular night float resident.
The third year (PGY 3) of training offers residents the highest operative volume (250 case average) during their training. Residents operate extensively on thoracic, gastrointestinal, transplant, vascular, and pediatric surgery, as well as at the county hospital. PGY 3 residents act as the senior resident at the county hospital and on transplant surgery. The third year residents also rotate through the trauma/burns intensive care unit. All rotations are seven or eight weeks in duration. Vascular, gastrointestinal, and transplant surgery call is covered by a night float resident during the week, making the on-service PGY 3 responsible for call one night, every other weekend. Call at the county hospital is home call, every third night. Pediatric surgery call is split with the other junior residents, and generally is every fourth or fifth night. ICU call is every third night. Second and third year residents taking every third night call in the trauma/burns ICU have every third day off entirely.
The fourth year of clinical training (PGY 4) continues the progressive assumption of greater responsibility, leadership, and decision making. Fourth year residents spend much of their time in the operating room, handling the more complex cases. The PGY 4 acts as the senior resident on the trauma, night float, gastrointestinal, and vascular surgery services. Senior resident duties are shared with a PGY 5 resident on the surgical oncology service. Other than trauma and night float, all call is at home and generally is every second or third weekend. All rotations are seven or eight weeks in duration.
The chief resident year of general surgery training provides increasing responsibility and independence. Residents are expected to maintain his/her service and are responsible for the instruction of junior residents and medical students. Chief residents rotate on the gastrointestinal, head and neck/oncology, and VA vascular surgery services in four month blocks. All residents easily finish with more than enough indexed cases required for graduation. Two fifth year residents are chosen each year to act as administrative chiefs, overseeing the residency program and working closely with the program director and chairman. Research In addition to the five years of categorical general surgery training offered at UAB, residents are given the option to complete two years in the clinical or basic science laboratory. Residents have no clinical duties and often moonlight during these years. Research projects are abundant and heavily funded. Some residents elect to earn a Masters of Public Health degree. Research residents work in the labs of dedicated research as well as clinical faculty. Most residents elect to complete their two years of research after the second clinical year. Research is completely optional.