The dynamic clinical curriculum of the General Surgery Residency Program prioritizes education over service, faculty trained to teach and hired with clear expectations of their role as facilitators of learning and an educational structure that values residents as a group and as individuals with separate learning needs and ambitions.
The six core competencies described by the Accreditation Council for Graduate Medical Education are at the heart of our teaching goals. The practitioners who graduate from this training program should be trained to embrace these competencies as core values in surgery. They are:
- Patient Care: Our graduates will demonstrate sufficient knowledge of the field of general surgery and sufficient technical ability to provide care that is appropriate and effective. Our graduates will be advocates for the promotion of good health and preventive care. In addition, our graduates will be trained to understand the human as well as the scientific aspects of medicine and exhibit compassion for their patients and the families of their patients. They will invest time explaining the plan of care and its possible consequences.
- Medical Knowledge: Our graduates will demonstrate commitment to lifelong learning and to studying evolving information in the biomedical, clinical, epidemiological and social-behavioral sciences and the application of this knowledge to patient care.
- Practice-Based Learning and Improvement: Our graduates are trained to investigate and evaluate the results of their own practice of medicine, incorporating new scientific evidence and improvements in patient care into their practice as appropriate. They are willing to seek the assistance of their colleagues when necessary to remedy deficiencies in their practice outcomes. Practice-Based Learning and Improvement also includes honing teaching skills A Residents as Teachers curriculum is embedded into the overall curriculum to advance teaching and performance assessment skills.
- Interpersonal and Communication Skills: Our residents are trained in effective and respectful information exchange with patients and their families and in productive, courteous relationships with other health professionals.
- Professionalism: Our graduates are committed to carrying out their responsibilities to their patients as their highest priority. They are taught to be respectful of the diverse characteristics and cultures of their patients. As professionals, they adhere to ethical principles above all else.
- Systems-Based Practice: Our residents are taught to be aware of the larger context and system of healthcare and to effectively use system resources to provide care that is of optimal value. As a university-based residency program, we also believe it is an important part of our mission to train residents who will ultimately discover new knowledge that will improve the care of patients. As such, we wish to provide opportunities for scholarly work in clinical, behavioral and basic research for all surgical residents.
- Technical Skills: Our PGY1 and PGY2 residents participate in separate but complimentary skills lab curriculum. The transfer of learning from the lab to actual patients is assessed through direct observation by faculty or senior residents who complete a checklist verifying the resident safely administered the skills/procedure during patient care under their direct supervision. At year end, the PGY1s and PGY2s undergo a Verification of Proficiency practical exam that employs an OSATS type format with faculty verifying proficiency of each skill through observation and written feedback. Senior residents complete a six-session curriculum that focuses on selected operative procedures. Senior residents also complete the FLS curriculum and examination.
Patient ownership is the foundation of our clinical curriculum. Longitudinal relationships (preoperative, intraoperative and postoperative) with patients enable residents to build trust and hone important communication and interpersonal skills and a sense of personal responsibility. Developing skills in diagnostic decision-making and learning how to determine who needs an operation — and, if so, what type and when — is learned through supervised autonomy in the outpatient and inpatient settings. Participating intraoperatively with your patient at whatever level of involvement is appropriate does not necessarily depend on the postgraduate year, but rather resident readiness. Our clinical curriculum, structured as apprenticeships (one-to-one or -two faculty ratio), small teams and night float formats, provides early and ongoing opportunities in clinical problem solving and technical skill development. Seeing a patient postoperatively exposes the results of a surgical intervention and allows a resident to learn what it was like for the patient during the immediate postoperative period, what healthcare support systems were needed and how the operative experience affected the patient's emotional and physical well-being. Throughout the curriculum, residents are encouraged to reflect on what they learned from a patient and how they can improve or have served that patient better.
First-year residents are assigned a faculty mentor as well as a senior resident mentor. The purpose of the mentor system is to personalize a large residency program, provide each resident with a faculty advocate and foster a professional intimacy between individual residents and a designated faculty member. The mentor system provides residents with a role model or faculty resource person to discuss professional and personal issues should they feel the need to do so. Residents can change mentors any time after their second year if they'd prefer to be mentored by a faculty member in the resident's chosen specialty.
Our residents also work with a designated faculty member referred to as the Team Education Coordinator (TEC) at the start of each clinical rotation to determine their learning needs, negotiate learning objectives and outline "tailored" instruction and practice needs for each resident. Each resident is also paired with a mentor at the start of the program who guides residents as they develop professional and personal goals, reviews performance evaluation data from faculty members every six months and helps translate any negative feedback into constructive challenges. This one-on-one relationship keeps residents on target to ensure each resident's "big picture" goals don't get lost in the day to day bustle of a resident's life.
Our residents receive exposure to the preoperative, operative and postoperative care for patients in the principal components of general surgery: specifically, diseases of the head and neck, breast, skin and soft tissues, alimentary tract, abdomen, vascular system, endocrine system, the comprehensive management of trauma and emergency operations and surgical critical care. In addition, we will provide clinical experience in cardiothoracic surgery, pediatric surgery, plastic surgery, transplant surgery and endoscopy. Preliminary residents are provided selected clinical experiences based upon the resident’s interests.
Each rotation is a "course" with learning objectives, clarified performance expectations, list of operations, description of the rotation's logistics and clinic/OR schedule and criterion on which the resident will be evaluated. There are four types of clinical rotations, including apprenticeships, small teams, an elective and night float rotations. These variations are included to proactively take advantage of as many learning opportunities as possible given the 80-hour work week, ensure junior residents are exposed early to the operating room and provide continuity of care and education. Each rotation, regardless of type, has a Team Education Coordinator (TEC). This surgical attending is responsible for orienting residents to the rotation, providing mid- and final rotation feedback, ensuring learning objectives are clear and mastered by the end of the rotation and for providing a performance evaluation report that outlines the resident's strengths and weaknesses.
On all clinical rotations, the care of patients is ultimately the responsibility of the attending surgeon. Nevertheless, responsibilities for patient care is assigned to residents at the discretion of the attending surgeon. For residents in the junior years of the residency, such responsibilities may include observation of the preoperative treatment planning, participation in straightforward operations, monitoring of patient condition following surgery, arrangement for discharge and participating in follow-up care in the attending surgeon’s office. For residents in the senior year, responsibilities may including formulating a preoperative plan of care for approval by the attending surgeon, participating in complex operations, monitoring of patient condition following surgery, ordering appropriate tests, making recommendations for change in postoperative treatment as indicated and participating in follow-up care in the attending surgeon’s office.
The following conferences are designed to supplement residents' self-directed learning. Residents' education time is protected to enable maximal participation and attendance.
Our Core education series is based on the This Week in SCORE curriculum. Conference preparation material is sent out from the speakers a week in advanced and residents are reminded that more readings and modules are available on the SCORE website.
This one-hour seminar provides updated on a range of cutting edge topics from our Northwestern faculty as well as numerous prominent visiting professors each year.
PGY 1 Conference
First-year residents arrive with a range of skills and background knowledge. The aim of this conference series is to bring first-year residents up to speed as a group on skills and topics that are useful to the junior resident.
Skills Lab Curriculum
Skills sessions are simulations housed in our NU Simulation Center. Curricula are broken up between the intern, mid-level, and senior residents. Each session is facilitated by a designated faculty member who leads the teaching and provision of feedback within the simulation. Mentored practice sessions are also planned throughout this series to allow additional protected practice time with peer and faculty feedback. Skill acquisition is verified via "Verification of Proficiency" exams, where residents are evaluated by faculty and provided feedback on skills they have mastered and those skills in need of additional practice.
Morbidity & Mortality Conference
Each week, residents electronically report cases appropriate for presentation at M&M. A designated faculty member moderates the discussion and selects the patient cases to be presented. Each resident, having discussed the case with the faculty member prior to M&M, reviewed the appropriate literature and pertinent details, classifies the cause(s) of the patient's morbidity or mortality and presents a summary. The focus is not on blame or shame, but rather on what could have been done differently or better in an effort to best meet patients needs.
For more information please see our Morbidity & Mortality page.
Resident Seminar Series
This conference exists to include non-clinical subjects important to the development of a well-rounded surgeon. The topics correlate to the ACGME core competencies. Sample topics have included "Ergonomics in Surgery", "Financial Planning", and "Improve Based Team Training".
Resident as Teacher & Leader
Residents are expected to be good teachers to medical students, junior residents, patients and other health professionals. All residents progress through a Resident as Teacher & Leader program in the PGY 2&3 years. Residents receive feedback on their teaching skills, and a resident teaching award system is in place to recognize those residents who excel as educators.
Residents work on the "front lines" of healthcare. Once they graduate, they will be charged in ongoing quality assurance for the care of their patients. During their first year, residents undergo DMAIC craning (Define, Measure, Analyze, Improve, Control) and determine a project surrounding issues that influence the safety, efficiency and quality of patient care. During their PGY 2&3 years, residents collaborate with hospital administration to address a systems-based practice problem of mutual interest. Residents work with the other members of the task force to resolve the problem using the DMAIC method and present the outcomes of their projects at a Grand Rounds session dedicated to quality improvement.
See past Surgical Resident Quality Improvement projects.
Residents are strongly encouraged to engage in independent research during their residency. For those interested in basic research, two years of dedicated time is recommended. Basic research should be performed under the mentorship of accomplished investigators with a track record of extramural funding and known mentorship abilities. Research in clinical outcomes, education, health services and other areas is compatible with the department’s educational goals and will be approved if an appropriate plan is developed by the resident and the proposed mentor. Visit the Resident Research section to learn more.
The Resident Performance Evaluation System is designed to standardize the collection, communication and follow-up of resident performance evaluation data. It serves to clarify expectations of the residents and provides for a regular and timely formative (feedback) and summative (overall) evaluation system that meets the needs of residents and due process guidelines.
The information is used to:
- Make decisions on promotion across residency years
- Provide data to specialty boards for certification as requested
- Write letters of recommendation
- Identify areas of marginal performance and initiate corrective measures
- Note trends of weaknesses so to target needed modifications in the program.
Formative assessment or constructive feedback is given in an ongoing manner as an aid to learning. Its aim is to provide in a routine manner information that helps a resident understand what they did well and what they need to improve upon. Sources for formative assessment include the faculty, peers and self-assessment.
Summative assessment that reviews overall performance is carried out every six months. Performance data are used to assign residents an overall performance rating to help them gauge progress.
- Exemplary = Advance/promote with commendation for superior performance
- Satisfactory = Advance/promote - performance fully satisfactory
- Minor Deficiency = Retain/promote - minor concerns about performance
- Major Deficiency = Retain/promote - major concerns about performance - letter of concern
- Critical Deficiency = Retain but not promote next level - probationary status for serious concerns
- ABSITE: The American Board of Surgery In-Training Exam.
- Mock Oral Exam: This exam is taken by fourth- and fifth-year residents every year. It is developed and administered in collaboration with two other surgery residency programs so residents are evaluated by surgical faculty they do not know to avoid potential rater bias and to mimic more closely the ABS oral exam.
- Verification of Proficiency Exam: This exam is given to first- and second-year residents in the spring to determine their proficiency of specified technical skills learned in the skills laboratory.