Rv 9.20.22


Program Structure

In the PGY1 year postoperative care of the floor-level surgical patient, proper workup of common elective and emergency patient presentations, proper workup of stable trauma patients, and a strong foundational understanding of the natural history of surgical disease is taught. In the PGY2 year this progresses to postoperative care of the ICU-level surgical patient, proper workup of less common elective and emergency patient presentations, proper treatment of patients in shock, and proper workup of unstable trauma patients. PGY3 residents take overnight call as the senior resident at SJGH and learn to apply the skills and knowledge learned in the previous two years to acute presentations of surgical and trauma patients in the emergency department and start to teach bedside procedures and proper care of floor patients to the interns. PGY4 residents continue to learn how to teach a variety of learners in and out of the operating room, how to run a surgical floor service efficiently and safely, how to manage the many interests competing for their time, develop leadership skills (including at the UC Berkeley/Haas School of Business Physician Leadership Course), and become didactic teachers at our weekly conferences. Finally, PGY5 residents learn to take true ownership of their patients and services, advance their teaching skills to accommodate even a recalcitrant learner, learn to run even the busiest of trauma resuscitations and operations, and put the finishing touches on their base of surgical knowledge as they prepare for the written and oral boards.

We are currently redesigning our didactic curriculum. The new curriculum will be divided into separate junior (PGY1-3) and senior (PGY4-5) resident curricula. The junior curriculum will consist of 36 disease- and system-based months, and we hope to introduce it in January 2023. The four weeks of that month will consist of lectures from both senior residents and attendings to establish the foundational anatomy, physiology, and pathophysiology, as well as skills sessions to teach or simulate new procedural and cognitive skills. Sabiston’s Textbook of Surgery and various online resources will supplement these sessions. The senior curriculum will cover 24 months and will be divided into cadaver work to simulate uncommon operations, oral board preparation, environmental simulations of difficult operating room and trauma bay scenarios, simulation of difficult teaching scenarios, and more, and will be supplemented by Cameron’s Current Surgical Therapy. We hope to introduce the senior curriculum in July 2023.

As ours is a community residency program residents are expected to develop true operative independence and be capable general surgeons upon graduation. Our residents typically have one thousand major cases at the beginning of their chief year, and typically graduate with almost 1500 major cases. Our interns are expected to master the large majority of bedside procedures – central venous access, abscess incision and drainage, Foley and nasogastric catheter placement, intubation, bedside management and debridement of wounds, percutaneous and surgical chest tube placement, proper use of negative pressure wound therapy, upper and lower endoscopy, etc. – in their first six months and spend the second half of the academic year teaching some of these skills to medical students. PGY2s are expected to master the remaining bedside procedures – percutaneous tracheostomy, peripheral arterial access, bronchoscopy, suprapubic bladder catheterization, etc. – during their SICU rotations. In the PGY1 and 2 years our residents scrub into far more than the ACGME-required 250 cases, and in the latter half of the year the attending will often observe these cases unscrubbed while the senior and junior residents operate together. The PGY3 year is spent participating in the some of the more specialized areas of general surgery such as pediatric surgery, surgical oncology, and hepatopancreaticobiliary surgery at UC Davis, and beginning to operate independently on simpler general surgery cases while at SJGH and SJMC. Finally, in the PGY4 and 5 years the residents are typically in the operating room after morning rounds, managing their services from the operating room, and leading fellowship-level operations with attendings or taking junior residents through bread-and-butter general surgery cases with the attending available but in the background. Since there are no fellows at SJGH or SJMC there are no barriers between the resident and attending at these institutions, even in the most advanced cases.

Rotations by Year

All rotations are four weeks long, with 13 rotations per year. The year begins on July 1 and ends on June 30. UCD is in Sacramento, 55 miles north of SJGH, and residents are housed in an apartment across the street from the hospital while rotating there at the program’s expense. Each year’s typical resident schedule is organized as follow:

PGY1 (all rotations at SJGH)

  • SICU (1 month)
  • Trauma (2 months)
  • Blue/red general/vascular/HPB/colorectal surgery (6 months)
  • SJGH nights (2 months)
  • GI/endoscopy (1 month)
  • Anesthesia/IR (2 weeks/2 weeks)

PGY2 (rotations at SJGH and SJMC)

  • Blue/red general/vascular/HPB/colorectal surgery (5 months)
  • SJMC general surgery (4 months)
  • SICU (2 months)
  • Trauma (2 months)

PGY3 (rotations at SJGH, SJMC, and UCD)

  • Trauma (2 months)
  • SJMC general surgery (4 months)
  • SJGH nights (2 months)
  • Red general/vascular/colorectal surgery (1 month)
  • UCD transplant (1 month)
  • UCD surgical oncology (1 month)
  • UCD pediatric surgery (2 months)

PGY4 (rotations at SJGH, SJMC, and an elective at any accepting institution)

  • SJMC general surgery (4 months)
  • SJMC thoracic surgery (2 months)
  • Elective away rotation (1 month)
  • Trauma (1 month)
  • SJGH nights (2 months)
  • Blue/red general/vascular/HPB/colorectal surgery (3 months)

PGY5 (rotations at SJGH and SJMC)

  • SJMC general surgery (4 months)
  • Blue/red general/vascular/HPB/colorectal (9 months)