Training — Years III Through V

Grad Year III

Grad Year III consists of:

• General Surgery — 5 months
• Transplant — 1 month
• Breast Surgery — 1 month
• SICU — 2 months
• Pediatric Surgery — 1 months
• Trauma Surgery — 2 months

Grad Year III of the residency training program is designed to develop a broader approach to surgery. During this year, residents spend most of their time in the subspecialty services as outlined above.

Grad Year IV

Grad Year IV consists of:

• General Surgery — 8 months
• Cardiothoracic — 1 month
• Peripheral Vascular Surgery — 3 months

General Surgery

This year is the start of senior responsibility. Residents will be developing a comprehensive understanding of the primary components of General Surgery. By the end of this year, they are expected to understand the anatomy, embryology and pathophysiology of endocrine disorders. They will have a detailed understanding of the work-up and treatment of each of the surgically correctable endocrine diseases. Residents should have a thorough understanding of GI diseases and should manage nutritional needs in the normal and compromised GI tract. They will expand their skills in endoscopy.  Residents will perform more complex procedures, such as small and large bowel resections, and assist the chief resident and attending staff with complex GI cases. The fourth year will understand and use various incisional approaches to the abdominal cavity and retroperitoneum. They will understand the indications, use, and complications of the various peritoneovenous shunts and the principles of peritoneal dialysis. They will perform laparotomies from start to finish. The fourth-year resident will become intimately involved in the care and treatment of the trauma victim and with supervisory status over the junior residents, develops principles for rehabilitation and understand the capability of social work in meeting the needs of trauma patients. Residents will deal with, and critically address the controversial areas of breast disease; perform and be able to discuss various surgical procedures on patients with benign and malignant breast diseases. They will also develop an in-depth knowledge and have surgical experience with complex diseases of the liver, pancreas and biliary tract.

Cardiothoracic Service

One month is spent on the cardiothoracic service. Residents learn indications and surgical treatment of cardiac conditions and functions of the membrane oxygenator. They also learn to diagnose and manage patients with pulmonary lesions. Residents are expected to perform bronchoscopies, insert chest tubes and assist in major pulmonary and cardiac surgery. Residents learn the indications for and treatment of major cardiac lesions.

Peripheral Vascular Surgery

In the fourth year of General Surgery, residents spend four months on the peripheral vascular service which deals with both arterial and venous diseases. They are designated as senior residents of this service.

The peripheral vascular service is staffed by a small group of peripheral vascular surgeons. Residents make pre-operative and post-operative evaluations in the care of the patient. They learn to perform various arteriography procedures and review, with attending staff, the arteriography films and correlate these to the patient's disease process and subsequent treatment. Residents will have extensive experience in the management of abdominal aortic aneurysms, peripheral vascular occlusive disease, carotid arterial disease, various forms of vasculitis and venous diseases. Th resident's performance during this period is monitored very carefully by the attending staff and program director in an effort to determine whether or not the resident is ready for chief surgical resident responsibility.

Grad Year V

Grad Year V consists of:

• Administrative Chief Resident — 3 months
• Chief Resident, General Surgery — 6 months
• Chief Resident, Vascular Surgery — 3 months

The Administrative Chief Resident (ACR) is a position of responsibility, sharing, in part, responsibility along with the attending staff for the education of the junior residents on unit rounds, conferences, and as a teaching assistant in the operating room.

The ACR is also in charge of and responsible for the surgical clinic and is encouraged to see patients referred for consultation to attending surgeons. The ACR is also responsible, in cooperation with the Program Director, for updating monthly schedules, making surgical assignments and generally administering the day-to-day function of the surgery residency. The Chief Surgical Resident (CSR) is the leader of his division on his general surgical service.  He has similar teaching responsibilities for the residents on his service as described in the Administrative Chief Resident duties. 

The Chief Surgical Resident will act in part as junior staff. He will be encouraged to make decisions and plan courses of treatment to develop the confidence and skills necessary to become a complete surgeon. The CSR is still supervised by the attending physician, the supervision is in more of a collegiate manner. The chief resident on vascular service will continue to expand his knowledge in the treatment of peripheral vascular diseases. He will become more adept at vascular ultrasounds and vascular Doppler techniques. He will perform under the supervision of the attending surgeon the most complex peripheral vascular cases. He will coordinate pre-operative evaluation with the operative treatment and ultimately the post-operative care of these patients both in the hospital and in the office.

Grad Year V residents take SESAP examinations as well as the American Board of Surgery In-Training Examination, as do all residents, and are also examined by members of the surgical staff in sessions simulating the Oral Surgical Board exams.

During their five year residency, residents have the following breakdown in assignments:

• General Surgery — 33 months
• Cardiothoracic Surgery — 1 month
• Transplant — 2 months
• Plastic Surgery — 1 month
• Subspecialty Elective — 1 month
• Peripheral Vascular Surgery — 8 months
• Surgical Intensive Care Unit — 5 months
• Research and GI Endoscopy — 2 months
• Breast focused surgery — 1 month
• Pediatric Surgery — 2 months
• Trauma Surgery — 3 months

For more information or an application you can write to the following address or call (313) 343-3875.

Medical Education Department
St. John Hospital and Medical Center
22101 Moross Road
Detroit, Michigan 48236