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Clinical Experience and Rotations

Clinical Experience by Year

PGY-1

Interns are the front line of surgical residents at SLU Hospital. Our 5 categorical surgical residents work with other surgical subspecialty, anesthesia, emergency medicine, and preliminary residents. PGY-1 residents learn the basics of pre and post-operative care of complex patients as well as evaluate new patients in both the inpatient and clinic settings. This builds a knowledge base that will carry them into their later years. The operative experience includes level-appropriate cases, with teaching by both faculty and senior residents. While they are at the forefront of patient care, there are dedicated operative experiences that allow PGY-1’s to build their surgical skills. There are also opportunities to assist in complex cases to develop early exposure to challenging surgical pathology. The PGY-1 year includes rotations in Trauma, ICU, Acute Care Surgery, Transplant Surgery, Surgical oncology/Colorectal, Pediatric Surgery, Breast/Thoracic, and Vascular Surgery. Approximately 3 months are spent at Cardinal Glennon Hospital taking care of and operating on pediatric patients. Additionally, there are approximately 3 months dedicated to night float services, which allow a greater degree of autonomy with the supervision of a senior resident. Interns also occasionally have 24 hour-call responsibility. The PGY-1 year allows residents to acclimate to the demands of surgical residency and become an integral part of the surgical team. This allows them to transition into the next level of residency.

PGY-2

Second year residents see a sharp increase in their responsibility, autonomy in their patient care duties, and their care of critically ill patients. The first of the defining rotations of this year is the ICU Nights rotation. During this rotation, the resident spends at least two months caring for all the surgical patients in the SLU intensive care unit. In conjunction with the anesthesia critical care resident, they are the first responders to the complex issues of ICU patients during the night. They learn to take care of hemodynamically unstable patients, deal with routine and uncommon post-operative issues, and provide surgical evaluation of medical ICU patients. Residents become proficient in skills such as central line, arterial line, and tube thoracostomy placement. The ICU Nights resident is also an adjunct for trauma activations and serves to assist the chief resident with high-acuity trauma patients.

The second of the defining rotations includes the experience at SSM Health St. Mary’s Hospital. This allows the PGY-2 a unique position of being the sole general surgery resident at the hospital for an approximately two-month period. This serves in contrast to the team-based experience of the PGY-1 year; the second-year resident becomes both their own chief and intern. They run their service under the supervision of two attending general surgeons. This allows for a high operative volume and exposure to cases they would otherwise not be the primary surgeon on – as well as exposure to the obstetric population. This includes soft tissue, a variety of laparoscopic cases including cholecystectomies, appendectomies, ventral and inguinal hernias, as well as abdominal wall reconstruction. Call from home introduces residents to private general surgery and lends to emergency operative cases for acute surgical problems.

The second year also includes rotations at the Veteran’s Affairs hospital, which includes 24-hour in-house call responsibility as well as the opportunity to serve the veteran population. This includes vascular and general surgery, as well as an intense clinic experience to develop their evaluation of common surgical problems. The Burn rotation at Mercy Hospital allows residents to become experienced in burn care, which increases their breadth of experience. The year is rounded out by additional experiences in either the Trauma ICU, Breast/Thoracic, or Surgical Oncology/Colorectal services.

PGY-3

Third year residents have an increased emphasis on operative experience to prepare them for their years as chief residents. This year serves as a bridge between the responsibility of junior residents and the rigors of senior residency. This allows them to become increasing technically adept in the operating room. PGY-3 residents cover chief-level call when chief residents have days off, as well as serve as mentors to junior residents. Rotations include the VA Hospital, where they have increased operative experience as compared to the PGY-2 year. This is the first year that residents rotate on the Trauma and Acute Care Surgery rotation at Mercy Hospital Saint Louis, where they are the primary resident for trauma activations and have a large operative volume. They also cover nights at Mercy with a combination night-float and call system, which includes triple coverage of Trauma, General Surgery, and Burn. This year also includes a return to the Acute Care Surgery Service, which functions to improve their clinical decision making and operative skills, as well as serve to assist other services with operative duties to broaden their experience. The year is rounded out with the Pediatric Surgery rotation at Cardinal Glennon, where they serve as the most senior general surgery resident on the service, manage NICU and PICU patients, and participate in more complex operations. A one-month elective aids in career exploration and intense experience in the resident’s field of choice.

PGY-4

Fourth year residents are the most senior residents on their service and serve as the chief of their team. The goal of this year is to develop leadership abilities to manage their patients and guide junior residents. This year is concentrated on trauma, with a mix of 2-3 months of daytime trauma with 2-3 months of Trauma Night Float. The day Trauma Chief is responsible for trauma activations, overseeing floor trauma residents, and operating in scheduled and emergent trauma cases. The Trauma Night Float Chief oversees the overnight PGY-1 and PGY-2 residents, and they are responsible for overseeing trauma activations, staffing consults for general surgery, assisting with ICU management, and operating on emergent cases. PGY-4 residents also serve as the transplant surgery chief and participate in liver, kidney, and pancreas transplantation as well as general surgical cases on cirrhotic and transplant patients. This year includes the Breast/Thoracic surgery rotation to allow for complex esophageal and thoracic cases as well as becoming practice ready for general breast surgery. The final rotation included in the PGY-4 year is Mercy Hospital, where PGY-4’s gain increased autonomy on the Trauma and Acute Care Surgery service.

PGY-5

The final year of training at Saint Louis University is geared towards further honing the trainee’s surgical, clinical, and leadership skills with the goal of preparing the chief resident for independent practice or fellowship training. Chiefs lead their services with the goal of mastering the highest level of operative complexity and autonomy. They serve as role models and educators to their junior residents by learning through teaching. Rotations of this year include the VA Hospital, Surgical Oncology/Colorectal, Mercy Hospital Trauma and Acute Care Surgery, and SLU Acute Care Surgery. At the VA, chiefs lead junior residents through cases with attending supervision, while honing advanced general surgical and laparoscopic skills. Time at Mercy Hospital allows for mastery of fundamental general surgery and preparation for private practice. SLU Acute Care Surgery sees the highest acuity urgent and emergent patients, preparing trainees for whatever medical and surgical challenges they will encounter in their career. The Surgical Oncology/Colorectal rotation provides for the challenge of complex hepatobiliary and gastrointestinal operations including laparoscopic, robotic, and open experience in both fields. The clinic experience across these rotations also prepares chief residents to excel in the outpatient component of their future career. Together, these final clinical rotations allow graduating chiefs to not only feel comfortable in their future field but to also have the skills and confidence necessary to perform at their highest level in any setting.