The core teaching staff at NYHQ is composed of six full-time surgeons with expertise in general surgery, trauma, surgical critical care, oncology, vascular and colo-rectal surgery. Five surgeons from the voluntary attending staff and the Department’s chief Physician’s Assistant comprise the remainder of the core teaching staff. Staff from meet monthly to evaluate resident performance, determine policy for the program, and to advise the Chairman.
The teaching staff has the major responsibility for providing resident and medical student education. Members of the staffs have a substantial diversity of interest, allowing expert instruction in virtually all facets of surgery. The full-time faculties keep their private offices in the hospitals and carry beepers to ensure availability to the residents. Large voluntary teaching staffs supplement the teaching core at each institution, and all patients in the hospital are cared for by residents.
Attendings are assigned to cover clinics, emergency admissions, and operations. This is considered a privilege, and not a prerogative. Only those attendings deemed qualified and committed to teaching are allowed to take call. These attendings supervise the residents in their care of “service” patients, but no distinction is made between such patients and “private” patients with regards to teaching. All surgical patients are included in bedside teaching rounds and in discussions at M&M and departmental teaching conferences.
An attending is present at each operation. He/she may allow the chief resident to take a junior resident through a case, but the attending must still be present in the operating room. The only exception to this is in an emergency when the chief resident may start a case while awaiting the attending’s arrival at the hospital.
Growth In Skill… Growth In Responsibility
Our program is designed to provide the trainee with graduated responsibility and to allow resident decision making within good medical practice while abiding by the regulations of the New York State Health Code. Thus, residents are allowed and encouraged to exercise more responsibility and independent thinking as they progress in experience and judgement.
The following describes the usual progression in resident responsibility:
- The first year resident learns the basic care of the surgical patient. He/she must be directly supervised for all procedures until credentialed for that procedure. Rounds are made twice daily with the chief resident at which time all patients are evaluated and the plans for the next twelve hours are established. In the operating room the PGY 1 scrubs with an attending or chief resident ( with an attending present). In the outpatient department, the PGY 1 sees patients and then consults with senior residents or attendings before making any major decisions.
- The PGY 2 supervises the activities of the PGY 1 on the floor and acts as the surgical consultant to the Emergency Room. He/she is called to evaluate and triage surgical patients. The ER is under the supervision of a full-time ER attending and all patients must be seen by that individual prior to discharge. The PGY 2 calls a more senior resident for assistance and guidance when needed.The PGY 3 works as a senior resident on the surgical teams and in the SICU where he/she is expected to make patient care decisions under the supervision of the SICU attendings. When on call at night, the PGY 3 can always find a more senior resident in the house for consultation and assistance.
- By the fourth year the resident has matured enough to assume leadership on one of the two surgical teams. He/she provides consultations for the other services, and, if experience and skills allow, begins functioning as a teaching assistance in the OR for minor cases. When on-call at night, he/she has leadership responsibilities. However, Because NYHQ is a Level I trauma center, there is always a PGY 5 present at night.
- The Chief Resident (PGY 5) is close to a “finished product.” If he/she has done an appropriate number of cases, he/she may act as an OR teaching assistant under attending supervision. Chiefs are encouraged to think for themselves and make independent judgments concerning patient care. After making decisions, the chief will notify the attending to explain his/her plan. Chiefs take call at night within the hospital at NYHQ when covering trauma.