General Surgery Residency Curriculum

Each week, at each of our major teaching hospitals, the chief resident of the service reports all cases that with unexpected events or untoward outcomes related to their surgical care, as well as interesting cases. A resident team member [and/or student, as appropriate] who was involved in the patient’s care reviews the medical record and presents the case for discussion to his/her peers, teaching faculty and other learners during the conference.

The program director or designee [APD, hospital Site Director] will facilitate an open, collegial discussion between the presenting resident and the other attendees. In addition, the presenting resident[s] will review and present key literature related to the case and/or specific outcomes, to contribute to new learning and up-to-date knowledge for all attendants. The goal is to learn from each case and to improve the care for our future patients. At the end of each conference, the residents should be able to:

• Identify/diagnose patients with the specific untoward outcomes or complications, discussed and describe typical signs, symptoms, findings]
• Recognize/list typical contributing/pre-disposing factors and patients at risk
• Identify/analyze contributing systems/resource issue [as applicable]
• Formulate and initiate appropriate/effective diagnostic work-up
• Verbalize/employ concrete steps to prevent future occurrences and improve the care for patients at risk, incorporating evidence-based practice
• Cite at least one important new concept learned
• Assess and verbalize personal needs for future learning

Conference time: Wednesday Mornings 7:00 – 8:00 AM, each teaching hospital.

The Trauma service at St Mary’s Hospital holds daily team sign-out meetings where all cases from the night before are discussed between students, residents, teaching faculty and key trauma [QI] personnel. In addition, once a month, the service conducts Trauma Morbidity and Mortality Conference, where the residents on the trauma service present and discuss cases with unexpected events or outcomes, related to their surgical care, with the trauma team leaders. The Trauma Director or designee facilitates a case discussion between students, residents, faculty, and other learners, with the goal to learn from each case and to improve the care for our future patients. The general goals and objectives outlined for the Surgery Morbidity and Mortality Conference apply.

Conference time: Wednesday mornings 7:00 – 8:00 AM, St Mary's Medical Center

Several of the teaching hospitals maintain monthly Tumor Board Conferences. These multidisciplinary educational conferences involve cancer specialists from surgical oncology, medical oncology, radiation oncology, radiology and GI and/or pathology, and are held on different days of the month at the various hospitals. The senior or chief residents assigned to the respective services will have the opportunity to present interesting cancer cases and discuss the medical/surgical management and relevant literature with a comprehensive panel of specialists.

In addition, there is a weekly Breast Surgery/Breast Cancer conference held at the Lynn Cancer Center and Center for Women's Health and Wellness; this conference is attended by the Boca Regional Hospital breast surgery faculty, breast radiology faculty, and faculty from pathology, medical- and radiation oncology, as well as ancillary healthcare providers. Junior residents assigned to the breast rotation will have the opportunity to present cases and discuss the medical/surgical management and relevant literature with a comprehensive panel of specialists.

Times and Dates vary by site. Breast Conference is Tuesday mornings 8:00 – 9:00 AM

On a weekly basis, teaching faculty from our core hospitals, as well as invited specialty faculty, give lectures on the core topics of General Surgery and its relevant specialties. Each of these educational activities will give a brief overview on important basic science concepts and review the core clinical concepts, as well as key information on diagnosis and management. Each activity will have time for questions by the residents, and the opportunity for interactive discussion. The core curriculum covers all basic and advanced topics of the S.C.O.R.E. curriculum and all areas relevant to the American Board of Surgery examination, in addition to reviews on "state-of-the-art medicine" topics.

Residents are asked to prepare for these lectures through independent reading to strengthen their own learning. Major subject areas [i.e. esophagus/stomach & duodenum, colon & rectum, aorta & great vessels, Lungs & Mediastinum, etc.] are presented in cohesive 4 to 5-week blocks to enhance learning. Each topic block is supplemented with resident-given lectures on pertinent basic sciences [anatomy [patho-]physiology, biochemistry and endocrine regulation, and pharmacology, etc.], and cadaver-based anatomy session on the area under discussion. At the end of each block, each resident is given the opportunity to assess his/her knowledge gain through a 30-40 question MCQ test, which also helps the residents to prepare for the annual ABSITE exam. The curriculum cycles on a roughly every 2-year basis, so that every resident will have more than one opportunity to review a particular topic area. Unlike the M&M sessions, which are hospital-specific, the core curriculum is distributed by live webcast to each hospital, so that the residents at each teaching site have the opportunity to participate in real time.

Conference time: Friday mornings 8:00-10:00am, activity webcast to all teaching sites

Understanding of scientific methods, from the appropriate design of research studies to the analysis of the results and synthesis of conclusions, as well as the active/ongoing participation of each resident in scholarship, are of great importance to the FAU Program in General Surgery. In our monthly Research Collaborative, attended by the residents, faculty, students and other learners, the residents are introduced to the concepts of research in a structured, systematic fashion.

The residents learn about study design, types of investigations, bias, statistical methods, appraisal of existing evidence among other topics, and are given the opportunity to present their own projects to the faculty and their peers. In conjunction with the programs "1-Project-Per-Year" goal, the resident’s ongoing involvement in a QI-project, and the opportunities for scholarship during the value-added year, the program sets the stage for residents to be productive in scholarship, well above the national average. At the end of each year residents are given the opportunity to present their work at the resident research day/the QI-project competition.

Conference time: 2nd Friday morning of the month 9:00 – 10:00 AM

Aligned with the Core Curriculum [topic blocks], once a month, junior and senior residents dissect an anatomic area of the body in preparation of a faculty facilitated interactive session with all the residents that discusses the relevant surgical anatomy, surgical [operative] access and pitfalls, and gives the residents a more in depth [3-D] understanding of the relevant anatomy. This activity is carried out in the state-of-the art anatomy facility at the FAU main campus.

Conference time: 1st Friday morning of the month 9:00 – 10:00 AM

Developing each resident in his/her role as a teacher is one of the important goals of the program. The residents are given numerous opportunities to review, present and discuss interesting cases in Morbidity and Mortality Conferences, Tumor Board and Breast Canter Conference; in addition, the residents are actively involved in the education of the FAU medical students and other learners on the surgical services.

The resident lecture series gives the residents the opportunity to systematically review the relevant basic sciences [anatomy [patho-]physiology, biochemistry and endocrine regulation, and pharmacology, etc.] for the ongoing core curriculum topic, and present a concise summary to their peers. Adding a question and answer session helps the residents prepare for the basic science portion of the ABSITE and the Boards.

Conference time: 3rd Friday morning of the month 9:00 – 10:00 AM

During the critical care rotations, the residents will experience bedside instruction, exposure to the SCCM Fundamentals of Critical Care Medicine content, and at least on a weekly basis, educational activities designed to familiarize them with the core knowledge needed to take care of critically ill surgical patients.

The residents will learn through lecture style presentations and interactive learning, through faculty discussions [white-board], and resident-driven review of key literature. The curriculum covers 10-12 core areas of critical care knowledge in conjunction with preparatory self-study, including: 1) respiratory failure/ARDS and ventilator management, 2) Cardiovascular failure, shock, volume and inotrope/pressor management, 3) Coronary syndromes and cardiac arrhythmias, 4) Acid-base and electrolyte management, 5) infection and antibiotics [pulmonary, urinary, bloodstream, surgical site, sepsis, other), 6) critical care metabolic changes, gastrointestinal failure and nutrition support, 7) coagulopathy, bleeding and correction of deficiencies and blood transfusion, 8) sedation, pain management and ICU delirium, 9) renal failure and renal replacement therapy, 10) critical care diagnostics indications and limitations, 11) considerations and pitfalls for core critical care procedures; a detailed list of topics is available for review.

Conference time: variable

The Department of Surgery is planning monthly grand rounds where invited speakers talk about the latest developments in the management of surgical diseases.

Examples of planned Grand Rounds topics include, but are not limited to:

• Health disparities
• unconscious bias in healthcare: Impact on diagnosis, treatment and outcome
• The curative potential of [stem] cell transfer immunotherapy in the treatment of human cancer.
• Living donor transplantation: A timely resurgence in the face of persistent organ shortage?
• Diabetic foot ulcer: a costly pandemic
• surgical multimodality management
• Surviving sepsis: the new evidence-and how we are doing
• Curing metastatic Colon Cancer: new challenges and opportunities
• A multi-disciplinary approach to patient-centered venous thromboembolism prophylaxis
• Contemporary surgical strategy paradigms for [advanced stage] ovarian cancer
• Traumatic Brain Injury: current diagnosis prevention and management
• Laparoscopy
• robotic surgery
• N.O.T.E.S. – tools for global health?
• Coronary artery bypass surgery [and the management of coronary disease] in the modern world
• A Half Century of Surgical Nutrition: Reflections, Controversies, and Challenges
• Local Therapy of Breast Cancer: Is Less Really More?
• Vascularized composite allotransplantation potentials & challenges in complex wound management
• Evolution in Pancreatic Cancer Care: Population-Based Outcomes to Patient-Centered Care
• Advancing the Practice of Surgery: The Importance of Surgical Research
• Evolution of Minimally Invasive Esophagectomy

Conference time: variable

Several of the teaching hospitals specialty services maintain regular journal club meetings, where students, residents, faculty and other learners discuss new and pertinent literature, relevant to the specialty area. Residents are encouraged to participate while on the specialty rotation, but may attend at any time.

Conference time: variable/as scheduled