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Clinical Experience

Surgery

Residents acquire an understanding of the principles of General, Trauma, Vascular, Pediatric, and Transplant Surgery as well as Surgical Critical Care and Endoscopy during their Residency. During their clinical experience these residents function at a level of responsibility commensurate with their level of training and achieve clinical educational milestones defined in the Goals and Objectives outlined for each rotation. 

General Surgery:
Residents receive extensive training in the full spectrum of general surgery including complex laparoscopy, pancreatobiliary surgery, and tumor surgery while rotating on numerous general surgery services. All services are staffed by residents as there are no fellows. Residents can expect to be participatory in all operations. The GI/Laparoscopic service typically performs 10-15 complex laparoscopic and bariatric procedures per week to include but not limited to gastric bypass/sleeve gastrectomy/duodenal switch, laparoscopic gastric and colorectal resections, and laparoscopic hernia repair. While on the GI/Pan-creatobiliary service, the residents participate in 5-10 cases per week that consist of major pancreatic resections, operations for acute and chronic pancreatitis, and major biliary reconstructions. The surgical oncology service cares for patients with breast, soft tissue, and gastrointestinal malignancies with a case load of approximately 15 cases per week which includes breast biopsy/mastectomy/sentinel node biopsy and axillary dissection, major liver and pancreatic resections, and soft tissue sarcoma resections. 

Trauma Surgery:
The Trauma Service covers all trauma and acute care surgery at MUSCMedical Center. It is a high volume complex service that performs 10-15 operations per week with a split between operative trauma and acute care surgery. Common acute care surgery cases include laparoscopic appendectomy, Hartmann’s procedure for diverticulitis, and exploratory laparotomy for bowel obstruction. The operations for trauma are chest and abdominal exploration for both blunt and penetrating trauma. In addition, there is roughly one ER thoracotomy per month. Again, the general surgery resident is fully participatory in our Level 1 trauma center as there is a critical care fellow but no trauma fellow. 

Pediatric Surgery:
Residents at the PGY 1, 2, and 4 levels are assigned to Pediatric Surgery. The PGY 1 rotation is for one month, while the PGY 2 and PGY 4 rotations range from 2-3 months each at MUH (the Main hospital). The PGY 4 serves as the acting chief for this service. Resident responsibilities include care of inpatients, attendance in the main and ambulatory operating rooms, and attendance at the weekly outpatient clinic, all under the direct supervision of the Pediatric Surgery attending staff. This is one of the busiest operative services with each Resident (PGY 2 and PGY 4) performing 10-15 cases per week. The PGY 4 General Surgery Resident scrubs on all major neonatal cases as there are no Pediatric Surgery fellows. 

Transplant Surgery:
PGY 1, 3 (kidney/pancreas/vascular access), and 4 (liver) residents are assigned to Transplant Surgery at MUH for 1-2 months. The PGY 3 or PGY 4 resident always serves as the acting chief for this service. Residents are involved in preoperative care of outpatients and in the operative and post-operative care of inpatients. Residents are also given the opportunity of traveling to outside hospitals for organ recovery when appropriate. Residents at the PGY 2 and 3 levels from two other outside general surgery programs rotate for one month on Transplant Surgery due to the patient volume and attending staff expertise. 

Community Surgery:
MUSC General Surgery residents benefit from a broad exposure to community general surgery practices. Starting in the 3rd year, our residents rotate for two months at McLeod Regional Medical Center in Florence, SC. The resident assumes a junior partner role in the practice and evaluates all patients preoperatively and postoperatively in the clinic. Cases are performed by the resident with assistance of a senior partner in the practice. The practice covers the full spectrum of general surgery including breast cancer management, biliary disease, and colon resection. In the 4th year, we rotate with two private practice groups in Charleston. Two months are spent at the Roper St. Francis Healthcare System where one month is spent with a busy general surgery practice, and the other with a colorectal subspecialty group. There residents perform high volume "bread and butter" general surgery cases such as hernia and cholecystectomies, while also gaining experience in advanced oncology including esophagectomies and colon resections. The Roper colorectal experience is highlighted by significant exposure to robotic pelvic dissections and advanced colorectal surgery. We rotate an average of 2 months at Trident Hospital where residents are again exposed to a complete general surgery practice with a significant robotics experience. All together, the community practice experiences are invaluable, and round out the broad training our residents receive. Functioning in an apprenticeship model in the latter years of training affords increased operative autonomy which is paramount in today's training environment.  

Thoracic Surgery:
All residents are under the direct supervision of the Thoracic Surgery attending faculty. They attend and participate in Thoracic Surgery clinics, conferences, special lectures, and have clinical responsibilities for patient in the operating room as well as on the wards and in the CTICU. PGY1 residents rotate for one month on Cardiothoracic Surgery at MUH. Their primary inpatient responsibilities involve providing pre- and postoperative care for patients admitted to the nursing unit. PGY-4 Residents have exposure to a wide variety of complex thoracic procedures and act as the Chief Resident for 1-2 months on the Service. Vascular Surgery:General surgery residents rotate both at the VA and MUSC as the chief of the vascular surgery service. Exposure is gained in both open and endovascular technique. A typical week for a vascular resident includes two endovascular aneurysm repairs, 2-3 endovascular interventions for lower extremity occlusive disease; 1-2 lower extremity bypass procedures, and 1-2 carotid endarterectomies. 

Plastic Surgery:
Experience in Plastic Surgery is gained at the PGY 1 level during a one month rotation at MUH. This experience includes assisting in the management of inpatients as well as performing evaluations and workups on plastic surgery patients under the supervision of the attending staff. In addition to operative care, Patients are seen in the ambulatory care setting at the Plastic Surgery outpatient clinics at MUH and VA. Residents on General Surgery at VA also often participate in the pre-, intra-, and postoperative care of Plastic Surgery patients at that institution. 

Critical Care Management & Endoscopy:
The residents have opportunity to manage patients with complex medical problems and those requiring major resuscitation, critical care and nonoperative trauma care. These opportunities primarily occur in the Surgical Trauma ICU (STICU) and the Cardiothoracic ICU (CTICU). In addition, Surgery Residents are provided a plethora of endoscopy opportunities early during their training.