Carolinas Medical Center

Carolinas Medical Center is a 861-bed tertiary care medical center and Level I trauma center, the nucleus of an integrated medical care network that supports a population of more than one million persons. In addition, this hospital is the hub of an extensive regional primary care physician network called Carolinas Physicians Network This balance provides a large volume and variety of surgical experience ranging from simple to the most complex surgical problems.

GENERAL SURGERY RESIDENCY

The General Surgery Residency Program at Carolinas Medical Center is a five-year surgical training program, fully-accredited by the Accreditation Council for Graduate Medical Education. Our emphasis on education differentiates our medical center from other similar-sized, non-university hospitals. We have assembled a dedicated faculty, 26 full-time and 13 clinical faculty, with surgical expertise in all the principal components of general surgery. The goal of our residency program is to prepare general surgeons to enter academic or clinical practice. Added qualification through additional fellowship training is encouraged.

Three categorical positions are available each year at the PGY-1 level. In addition, two preliminary positions are offered for physicians planning to enter training in specialties other than general surgery, such as orthopedic surgery, urology or ENT.

Our program has five surgical services, which include three General Surgery services, a Pediatric Surgery service and a Trauma Surgery service. Each General Surgery service has a PGY-5 resident as chief with a faculty member attending each month. The Trauma Surgery service has a PGY-4 resident as chief and is attended by a faculty member with expertise in trauma and surgical critical care. Trauma Surgery attending physicians are in-house 24-hours a day, and General Surgery faculty are readily available on call.

Training in both basic and advanced laparoscopic procedures is an integral part of the General Surgery Residency Program. Surgical endoscopy is emphasized throughout the entire residency training with ample experience at each level of training, including flexible sigmoidoscopy, EGD, colonoscopy and therapeutic endoscopy.

The Department of Surgery at Carolinas Medical Center (CMC) offers a broad educational experience for all residents. This includes extensive operative experience (800-1,000 surgical procedures as surgeon over five years), varied experience in an active, outpatient clinic setting, and a variety of teaching conferences directed by resident physicians and attendings. Resident physicians work with all full-time faculty and with many community physicians who participate in the General Surgery Teaching Program.

Responsibility is progressive as a resident moves through the program, ending with the chief year, during which a resident takes full responsibility for his/her surgical service. Each Chief Resident takes responsibility of serving as the Administrative Resident. The administrative chief disseminates information to the residents, is a resident liaison at faculty meetings, and coordinates many activities of the General Surgery resident staff.

Clinical Experience
Clinical experience is gained primarily at CMC, with one optional month of specialized training in GI surgery in San Jose, Costa Rica. Resident physicians receive extensive training in all aspects of General Surgery including laparoscopic techniques, trauma surgery, transplant surgery and surgical critical care. Residents and faculty conduct General Surgery clinic, Endoscopy clinic, and Trauma clinic once a week. Pediatric Surgery clinic is held weekly. Daily work rounds are conducted by each service, and the attending surgeons participate in teaching rounds with the resident staff. One of the services (Red) is devoted to the care of emergency surgical cases (non-trauma) and the surgical clinic cases.

Transplant Experience
General Surgery residents have an exceptional opportunity for transplantation experience with rotations totaling four months at The Transplant Center at CMC. Our chief residents graduating during the 2004-2005 academic year averaged 31 transplant operations each as resident surgeon.

The Transplant Center offers the following programs:

1. Kidney Transplant Program including laparoscopic live donor
2. Heart Transplant Program
3. Liver Transplant Program
4. Kidney/Pancreas and Pancreas-after-Kidney Transplant Program

Laparoscopic Training
Training in basic and advanced laparoscopic procedures is an integral part of the residency program. Surgical endoscopy is emphasized throughout the entire residency with significant experience at each level of training, including flexible sigmoidoscopy, EGD, colonoscopy, and therapeutic endoscopy.

In association with the Department of General Surgery, the multi-disciplinary program for minimal access surgery, Carolinas Laparoscopic and Advanced Surgery Program - known as CLASP, was developed in 1997 to create a clinical and research institute at CMC. It includes all specialties involved in minimal access surgery. This program has greatly added to the referrals of patients requiring advanced laparoscopic surgery and has facilitated the creation of a two-year fellowship in laparoscopic surgery. General Surgery residents and the laparoscopic fellows share ample laparoscopic experience during their training. The fellows work closely with our surgical residents in caring for patients requiring laparoscopic surgical procedures. The surgical residents also benefit by their involvement in clinical and basic science research including writing and publishing of peer-reviewed articles and book chapters. Another important function of CLASP is to maintain a dry laboratory where residents can develop skills in laparoscopic surgery before experience in the operating room.

Resident physicians are given the opportunity to participate in many laparoscopic courses throughout the academic year. The courses scheduled for 2006 include the following:

* Laparoscopic ventral and incisional hernia
* Solid organ laparoscopic procedures
* Laparoscopic nephrectomy
* Laparoscopic procedures for esophageal reflux
* Laparoscopic and hand-assisted colorectal surgery
* Additional hand-assisted laparoscopic procedures
* Laparoscopic approaches to morbid obesity

Teaching Conferences
Teaching conferences are offered throughout the week for General Surgery residents and residents rotating from other departments. The following conferences are required:

* Basic Science - once a week
* Grand Rounds - includes Visiting Professors, Surgical Grand Rounds and Multidisciplinary Trauma Conference - each once a month
* Morbidity-Mortality/Quality Assurance - once a week
* Journal Club - once a month

Other conferences include:
* Minimal Access Conference
* Multidisciplinary Critical Care Conference
* Surgical Endocrine Conference
* Tumor Board

Instructional Courses Available to Residents
Instructional courses are held throughout the year under the direction of members of the Department of Surgery. Laparoscopic skills courses provide residents with the opportunity to practice laparoscopic procedures in a laboratory setting. These additional courses are available for community physicians as well as house officers:

* Sentinel lymph node biopsy techniques
* Laparoscopic approaches to morbid obesity
* Laparoscopic and hand-assisted colorectal surgery
* Percutaneous tracheostomy
* Inferior vena cava imaging and filter insertion
* Flexible gastrointestinal endoscopy
* Advanced Trauma Life Support
* Pediatric Advanced Life Support
* Advanced Cardiac Life Support

Educational Meetings
General Surgery residents are granted five work days per year to attend an approved educational meeting. All meeting determinations are made at the beginning of the academic year.

Library Services and the Information Resource Center
In addition to 24-hour-a-day access to the library in the General Surgery office with current surgical journals, Internet access and resident e-mail, the Information Resource Center at Carolinas Healthcare System is available for resident use. The Information Resource Center, located on the first floor of the Medical Education Building, provides comprehensive services to undergraduates, graduates and post-graduate healthcare providers in the eight counties associated with the Charlotte Area Health Education Center.

After obtaining the appropriate accounts, residents and faculty can access the AHEC Digital Library. The AHEC Digital Library (ADL) is an online information center offering a comprehensive collection of knowledge-based resources available from any computer via the Internet.

The available databases include:

* Medline
* CINAHL
* Clinical Evidence
* Cochrane Library of Systematic Reviews
* D.A.R.E.
* Best Evidence
* MDConsult
* Full-Text Journals
* OVID

In addition, these resources are also available through the ADL:

* Full-Text Books
* MDConsult
* Stat-REF
* Practice Guidelines
* Drug Information
* Patient Education

Approximately 6,000 books, 500 current journal titles and 2,000 audio-visual materials are held in the library's collection. Current issues of journals are displayed in a comfortable reading area, while older editions are bound and shelved in the journal stacks. When a book or journal is not in the library's collection or available on line, a book loan or photocopy of the article can be requested by interlibrary loan.

Library staff are available for assist with database searches, reference support, and database instruction.

The Information Resource Center is opened at the following times:

* Monday through Thursday, 8:30 a.m. to 8 p.m.
* Friday, 8:30 a.m. to 5 p.m.
* Saturday, 8:30 a.m. to 1 p.m.

Click here to see Carolinas Laparoscopic and Advanced Surgery Program: SPECIALIZED SURGICAL PROGRAMS

This article is reposted with thanks to Carolinas Medical Center.