The first-year residents (PGY-1) rotate through UMC and the VA. The PGY-1 resident functions as a member of a surgical care team. Responsibilities include evaluation and planning for treatment of patients, attendance at rounds, clinics and conferences, and assisting in the operating room.
The operative experience occurs early in this program. The opportunities to assist and perform operative procedures are readily available to the intern. While the junior house officers have significant responsibility, close supervision and backup by more senior house officers and faculty are always present. The high ratio of surgical attending staff to residents and the collegial attitude of the faculty allow above average supervision and support with clinical, operative, and academic activities. PGY-1 residents are expected to assume primary care for patients on their service on a day-to-day basis.
A major goal of the department is to train the resident to understand the principles of pre- and post-operative care. Each resident will meet all ACGME work hour regulations. This is accomplished through a variety of creative scheduling plans including an Emergency General Surgery Service and a Night Surgery rotation.
PGY-1 rotations include General Surgery, Surgical Oncology/Breast Oncology/Hepatopancreaticobiliary Surgery, Colorectal Surgery, Cardiothoracic/Vascular Surgery, Transplant Surgery, Emergency General Surgery, Trauma Surgery, Surgical Critical Care, and Plastic Surgery. Residents also rotate in General Surgery at the VA during the PGY-1 year.
In the second year (PGY-2), the operating experience extends significantly and an increasing amount of clinical independence is achieved. PGY-2 residents are the senior residents on the Surgical Critical Care Service and manage all aspects of complicated critical patients with guidance from the Critical Care Fellows and attending Trauma/Critical Care/Acute Care Surgeons. The PGY-2 resident also runs the Burn/Wound Surgery Service. They also function as a mid-level resident on General Surgery, Surgical Oncology/Breast Oncology/Hepatopancreaticobiliary Surgery, Colorectal Surgery, Cardiothoracic/Vascular Surgery, Transplant Surgery, Emergency General Surgery, and Trauma Surgery. At the end of this year, the PGY-2 resident will be ready for the transition to making senior level decisions and patient management algorithms.
The third year of the program is concentrated in General Surgery and Trauma Surgery, where the PGY-3 resident will function as the senior level resident on many of the services. They will serve as the senior on-call resident through which all consults will be filtered on the Emergency General Surgery Service, and will function as the senior trauma resident and primary operating surgeon for operative trauma cases. PGY-3 residents also rotate for several months at the Mike O'Callaghan Federal Medical Center where they will be the only surgical resident at any given time and have access to participate in any case being performed (General, Vascular, Colorectal, OB/GYN, Orthopedics, Plastics, Urology, ENT, etc.).
Fourth & Fifth Years
The fourth and fifth years of the General Surgery training program are designed to provide increasing senior level responsibility in patient care decision making and allow each individual to develop qualities of maturity and judgment which are the essence of the skilled surgical practitioner. The PGY-4 resident continues to supervise perioperative care given by the more junior members of the patient care team. Typical fourth-year rotations include senior level resident responsibility in General, Vascular, and Colorectal surgery at the VA, as well as General, Trauma, Cardiothoracic, Vascular, Transplant, and Emergency General Surgery at UMC. PGY-4 residents also serve as the sole resident of the Minimally Invasive/Bariatric Surgery service, where they get exposure to advanced laparoscopic and robotic surgical procedures. During the fourth year, residents also rotate on the Pediatric Surgery service at both the Children’s Hospital of Nevada and Sunrise Children’s Hospital.
The Chief Resident year (PGY-5) is spent on the various surgical services dealing with the primary components of general surgery almost exclusively at University Medical Center. The Chief Resident is involved with major elective procedures with emphasis on complex GI, Oncologic, Endocrine, Colorectal, and complex Minimally Invasive Surgery cases, as well as major Trauma and Emergency General Surgery. The Chief Resident will have his/her own outpatient clinic and will supervise junior and mid-level residents in clinic. Each chief’s clinic will have weekly OR block time and cases will be scheduled at the chief’s discretion after appropriate preoperative workup and discussion with the attending surgeon. Chief Residents will act as the primary surgeon for their OR block time, with faculty backup readily available, and will take junior and mid-level residents through the operations.
The senior resident is required to prepare and present at conferences and is responsible for the teaching and training of more junior house officers and students on his or her service. The final year of the General Surgery experience completes a progressively graded comprehensive training with increasing responsibility and accountability as required by the American Board of Surgery. Chief residents are encouraged to attend at least one major national surgical meeting during their senior year, which is sponsored by the Department.