Boston University Medical Campus
Surgery

The Junior Years:
The first two years of the Surgical Residency Program are a time of broad exposure to a variety of surgical settings. During these years, a mix of general surgical rotations and surgical subspecialty rotations occur. During the first two years, all categorical general surgery residents are assigned to specific rotations, meeting all residency review committee requirements for subspecialty exposure.  

Dr. Charles T. Howard in the surgical amphitheater (circa 1930).

Subspecialty experience includes rotations in urology, orthopedics, neurosurgery, surgical critical care, plastic surgery and pediatric surgery. Rotations during the R-1 year are one month in duration. In the second postgraduate year most rotations are two months long.  

The Senior Years:

In the R-3 year, categorical residents begin to accept more decision-making responsibility and participate in the surgical management of more and more complex cases.  All rotations are compliant with the ACGME 80 hour work week regulations.

  R-3 rotations include:

1)  Mozden Service (Surgical Oncology, Boston Medical Center Newton Pavilion) a tertiary surgical oncology experience under the direction of Dr. Michael Stone. This service manages complex surgical oncology and endocrine surgery patients. This service is lead by a chief resident. An intern is also assigned to this service. 

2) Smithwick Service (Vascular Surgery, Boston Medical Center Newton Pavilion) a referral vascular surgery rotation under the direction of Dr. Gary Gibbons. This service is run by the Smithwick Vascular fellow; there is an intern on this service as well. 

3) Chief’s Service - The resident on Chief’s service has exposure to patients with inflammatory bowel disease (both ulcerative colitis and Crohn’s disease), fore and hind gut malignancies, pancreatic and hepato-biliary disease as well as experience with laparascopic surgery, colonoscopy and upper GI endoscopy. This service is lead by a chief resident. Duties include consults in the CCU and ER, rounding twice daily with the Chief resident and attending all outpatient clinical activities with the Chief of Surgery.

4)  Emergency/Consultation (Menino Pavilion) This resident works as a ‘dayfloat’ on the trauma/general surgery service, responding to all emergency department consultations, trauma team activations and inpatient consultations. This resident is an important part of the trauma team taking primary responsibility for the work-up of all daytime trauma admissions. This resident is also responsible for management of the surgery consult service at the Menino Pavilion. This resident participates in the routine general surgery operative work load at the Menino Pavilion.

5)  Quincy Medical Center - The Quincy Medical Center is a community hospital which is very closely affiliated with Boston Medical Center. Dr. Gary Gibbons, our chief of vascular surgery, was recently appointed President and CEO at QMC. The resident on this rotation works in the office, operating room and floors on general and thoracic surgery patients in a community hospital setting. 

The R-4 year

During the fourth post graduate year residents are exposed to more complex surgical material and function as the chief surgical resident a large community hospital.  These rotations are compliant with the ACGME 80 hour work week regulations.

            1)  Cape Cod Hospital-  On this rotation, the R-4 resident is the chief of a surgery service of several junior residents and medical students. This resident is responsible for patient care, instruction of medical students and house officers, managing academic conferences, assignment of operative cases, and performance of the more complex and demanding operations. 

            2)  Menino Pavilion – Trauma/General Surgery - This resident working under a chief resident, manages trauma cases at the Level 1 trauma center, and is responsible for all facets of the care of general surgical cases at this site.

            3)  Menino Pavilion - Pediatric Surgery-  This resident is responsible for all facets of patient care on the pediatric surgery service on the Menino Pavilion. 

            4)  Boston VA Medical Center – The R-4 at the VA covers general, vascular and thoracic surgery cases on a service managed by a chief resident. This service alternates call responsibility with a similar service from the Brigham and Women’s Hospital.

The R-5 year

The Chief residency year is the pinnacle of the residency experience. Each chief is responsible for a defined service and is responsible, under the guidance of the faculty, for all patient care occurring on that service. Each resident rotates on the Mozden service (Oncology), Chief’s service (GI), Menino Pavilion team A (Trauma/General surgery), Menino Pavilion team B (Bariatric Surgery and Trauma/General Surgery) and the VA (General/Vascular/Thoracic).

On each service the chief resident is responsible for patient care, instruction of medical students and house officers, assignment of operative cases, and performance of the more complex and demanding operations. Appropriate surgical and academic supervision is provided by the surgical attending staff. Each year one of the five chief residents is chosen as administrative chief resident and works closely with the department chairman and program director on administrative arrangements.

                            *********************
             Training in Specific Disciplines

Endoscopy:
Training in endoscopy is provided by staff skilled in endoscopic techniques. The faculty are members of the American Society of Gastrointestinal Endoscopy, The Society for Surgery of the Alimentary Tract, the American Gastroenterological Association, and The Society of American Gastrointestinal and Endoscopic Surgeons. The general surgical training program provides a broad experience in endoscopy in the context of general and GI surgical rotations as follows:

1. The Chief ‘s Service at Boston Medical Center: The R1, R2 and R5 surgical residents on this service gain exposure to both upper and lower gastrointestinal endoscopy as a fundamental part of the rotation.
2. Boston VA Medical Center: R3 and R5 residents participate in the busy upper and lower GI endoscopy activity provided by the surgical service at the VA. Residents are exposed to cystoscopy while rotating on the urology service at the Boston VA Medical Center.
3. Cape Cod Medical Center: Residents participate in bronchoscopy while at Cape Cod Medical Center, where active thoracic practices support  the surgical residency.

4. Intraoperative choledochoscopy experience is gained during the senior level rotations in general surgery at both Boston Medical Center and the integrated and affiliated institutions. This procedure is performed on all General Surgery rotations in the residency.

    

   Residents are exposed to more than adequate numbers of endoscopic procedures.

Bariatric Surgery/Advanced Minimally Invasive Surgery

Residents at all levels in the program participate in advanced minimally invasive procedures including anti-reflux surgery, esophageal surgery, colectomies, splenectomies and adrenalectomies. In addition, Dr. Donald Hess, is the director of one of Boston’s largest bariatric surgery programs and performs an average of four to six laparoscopic gastric bypasses per week.

Emergency Medicine: (R-1 level of training)
The E.D. is staffed full time by attending physicians from the Boston Medical Center Emergency Medicine Department, which is a full academic department in the medical center. Residents gain experience in management of both acute and non-acute problems while in the E.D.

Residents rotating at all other hospitals are frequently responsible for the evaluation and work-up of surgical patients being admitted from the E.D., but have no primary responsibilities for Emergency Department patient care. The Emergency Departments of all hospitals in our surgical residency are staffed by attending Emergency Medicine physicians.

Surgical Intensive Care:
All residents spend at least two months on the Surgical Critical Care service at Boston Medical Center. Surgical Critical Care  is a section of the Department of Surgery and is under the direction of Peter A. Burke, M.D. This rotation involves a one month rotation at the Newton Pavilion SICU, where complex general surgery, orthopedic, urological, neurosurgical, gynecologic and otolaryngologic tertiary referral patients are managed. Residents also rotate for a second month at the Menino Pavilion SICU, a twelve bed ICU. Both ICUs are staffed by the same team of five intensivists , four surgeons and one anesthesiologist, all of whom hold certificates of special competency in critical care and who cover the service in rotation. Twice daily attending rounds are held in each ICU.

Residents are directly supervised and taught by the attending intensivists. A special academic curriculum is followed for each 2 month block with didactic lectures on critical care topics (both basic science and clinical) directed at the junior resident level.

At the Boston VA Medical Center, R2 residents are also assigned primary responsibility in the Surgical ICU. These residents are supervised by attending surgeons.

Cape Cod Medical Center has dedicated Surgical ICUs which are under the direction of Board Certified Surgeons. Surgical residents provide direct patient care to all surgical patients in the SICU under the direct supervision of the ICU director.

In all hospitals in the program, Senior residents (R3, 4, and 5) are responsible for following all SICU patients and working in concert with the Critical Care Team. Critical Care provided in all the hospitals of the surgical residency is supervised by Board Certified Surgeons, the vast majority of whom hold the certificate of special qualification in  surgical critical care.

Trauma:
The Boston Medical Center’s Level I Trauma Center has been continuously verified by the American College of Surgeons Committee on Trauma, Verification Review Committee since the inception of the trauma center verification program. Few Boston hospitals can make this claim. The Trauma Center at BMC admits between 1900 and 2000 patients per year. Approximately 30% are victims of gunshot or stab wounds, the remainder suffer from blunt injury. The Boston Medflight Helicopter service provides more than 180 admissions, from outlying hospitals. State of the art radiology, critical care, orthopedic and neurosurgical resources support the trauma center. Residents training at Boston University will feel comfortable managing all type of traumatic injury.

General Thoracic Surgery:  
Training in general thoracic surgery is provided at the R4 level at the Boston Medical Center Thoracic Surgical Service and the Boston VA Medical Center, where the resident cares for all the thoracic surgical cases in this busy referral center. The Quincy Medical Center and Cape Cod Medical Center provide additional Thoracic Surgical experience.

Cardiothoracic Surgery (R2):  
Residents assigned to the cardiothoracic service at Boston VA Medical Center are part of a busy cardiac service and are involved in pre-operative, operative and post-operative care of patients undergoing open heart surgery and work under the direction of Dr. Shukri Khuri, chief of cardiothoracic surgery. This resident is personally involved in all aspects of peri-operative and operative care of the cardiac surgery patient.

Pediatric Surgery (R1):  
Residents are part of a dedicated pediatric surgical team lead by a board certified pediatric surgeon at our Menino Pavilion. This experience includes a busy outpatient clinic experience as well as exposure to patient management in our dedicated pediatric emergency department. This rotation provides total preoperative, operative and postoperative care of pediatric patients. Exposure to pediatric trauma management is a key feature of this rotation as well. The pediatric surgery team manages most pediatric trauma patients admitted to the hospital. A specific curriculum of education in pediatric surgery is followed by Dr. Steven Moulton and the residents during pediatric surgical rotation.

Plastic Surgery (R1):  
The intern on this rotation is assigned to the plastic surgery service which covers both the Newton Pavilion and the Menino Pavilion. This service has three busy plastic surgeons who manage both complex reconstructive and cosmetic surgical problems.

Urology (R1):
First year residents spend one month on the Urology Service at the Boston VA. The responsibilities of the urology intern include both pre and postoperative management of patients as well as experience in urologic surgery. Residents are instructed on interpretation of CT, IVP, cystography and urodynamic studies.

Orthopedics (R1):  
Residents are members of the orthopedic team at the Menino Pavilion and receive thorough exposure to diagnostic and therapeutic management of orthopedic problems. This rotation includes a daily attending teaching conference where extensive discussion of fracture diagnosis and management occurs.

Anesthesiology (R1):  
This rotation stresses preoperative anesthetic assessment, airway management and pain control. Extensive experience with anesthetic induction, endotracheal intubation and intraoperative resuscitation is achieved on this rotation.

Gynecologic Surgery (R3,5):
While on the Mozden service, experience in gynecologic oncology is achieved through involvement in care of patients with gynecologic oncology problems who are admitted to a member of the faculty specializing in these areas.