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Overview of the UM General Surgery Training Program
Our goal is to train academic general surgeons who will provide the highest level of clinical care and advance the frontiers of surgical science through research and education.
To achieve this goal, we engage residents in a planned curriculum delivered via lectures and conferences, simulation (standardized patient encounters, inanimate and animate labs), online course materials, at bedside and in the operating room during structured rotations. Most residents also spend two years in a research lab, acquiring knowledge of basic and translational science and associated research skills under the guidance of a faculty mentor. Through appropriate supervision and guidance and a structured evaluation system, residents develop a high level of professionalism, as well as the requisite clinical and surgical skills.
Throughout the course of training, residents receive multiple layers of supervision. The staff physician is available daily for patient care and the formulation of treatment plans. Newer residents will be constantly relying on more senior residents for assistance, supervision, and reassurance.
The rotation schedule is designed to allow maximum exposure to both the Core General Surgery Requirements and the important Additional Components outlined by the Surgery Residency Review Committee (RRC). Our program comprises training take at four core facilities (University of Minnesota Medical Center, the Veterans Administration Medical Center, Regions Hospital, and Methodist Hospital) and several affiliated private hospitals. This experience exposes residents to the full range of surgical care environments, running the gamut from busy community hospitals to tertiary referral centers.
Education Goals
Our goal is to train residents so that they are competent in the six core competency areas as defined by the Accreditation Council of Graduate Medical Education (ACGME) and the RRC:
1. Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Surgical residents must:
2. Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences, as well as the application of this knowledge to patient care. Surgical residents are expected to:
3. Practice-Based Learning and Improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care. Surgical residents are expected to:
4. Interpersonal and Communication Skills that result in effective exchange of information and collaboration with patients, their families, and other health professionals. Surgical residents are expected to:
5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds. Surgical residents are expected to:
6. Systems-Based Practice, as manifested by actions that demonstrate an awareness of an responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Surgical residents are expected to:
Education Components
Education activities occur in four main components: Lectures and Conferences, Simulation, Online Education, and Structured Surgical Rotations.
1. Lectures and Conferences
Tuesday mornings constitute our formal “Education Day.” Each Tuesday hosts a Complications Conference, a Grand Rounds presentation, and Core Curriculum sessions for junior (PGY 1-2-3) and senior (PGY 4-5) residents. Attendance for the entire morning is mandatory for all residents at all training levels and sites, including those in the research lab, and is recorded. If the junior (PGY 1-2-3) Core Curriculum is cancelled those residents are asked to join the PGY 4-5 Core Curriculum.
2. Simulation
Simulation constitutes one of the fastest growing training approaches to emerge in recent years. At the University of Minnesota, we use standardized patients to prepare and assess residents’ interpersonal and communications skills and professionalism. We also have a comprehensive schedule of inanimate and animate labs in which we develop and assess basic technical skills, critical response and team skills, and more advanced surgical procedures (open and laparoscopic). Residents in their first through third years of training participate regularly in planned curricula delivered in the SimPORTAL, a fully-accredited Education Institute (Level 1) by the American College of Surgeons. Some of the curriculum elements are unique to the University of Minnesota; some are drawn from the ACS Surgical Simulation Skills curriculum available online. We also rely on the Fundamentals of Surgery (FLS) curriculum as developed and certified by SAGES. Residents in their second through fifth year of training also participate in animate labs focusing on minimally invasive procedures. The content of simulation training is shown below by PGY training level:
3. Online Education
In 2005, our Department developed the “Rotation as a Course” (RAC) program. Selected rotations were developed as hybrid, online / on-ground courses supported by Moodle online course management system. The goal of RAC is to organize teaching and support learning, as it occurs during a rotation. RAC courses include rotation-specific learning objectives, pre- and post-tests, online lecture presentations, electronic links to assigned readings and other resources, weekly case-based discussion topics (face to face), and end-of-rotation oral exams. Current RAC rotations (listed below) are all based at the University campus.
Our Department was one of the first in the nation to experiment with web-based learning as an adjunct to specifically defined curriculum at the rotation level. Our 2005-07 “Rotation as a Course” (RAC) pilot program preceded the SCORE Website Portal by about two years. In 2010-11, faculty representing 18 core rotations on the Surgical Education Council spent several months realigning the core topics taught on rotations with the SCORE Curriculum. The result is a formalized education plan for each rotation, complete with a syllabus (list of core topics), assigned readings and other resources; a schedule for weekly seminars and specialty conferences as well as teaching rounds; and an end-of-rotation oral exam based on core topics. For 14 of these rotations, faculty members created websites via the University’s Moodle system for managing these resources.
4. Structured Surgical Rotations
All rotations in the residency program have been structured to help residents achieve specific learning objectives aligned with the ACGME core competency areas. These objectives are delineated by training level as well as training site and rotation in the following sections. Education activities vary by training site and by rotation, but all contain the following elements:
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