General Surgery Residency: Education
The Department of Surgery at Beth Israel Deaconess Medical Center is one of three major teaching and research units of Harvard Medical School’s Department of Surgery. The program is non-pyramidal. The surgical housestaff is composed of 25 first year residents, consisting of 9 categorical (full five-year), and 16 preliminary residents (one- or two-year depending on the requirements of their chosen subspecialty). Generally there are 9 categorical , 4 non designated prelimiary residents and 1 rotating plastic surgery resident at the PGY-2 level. In the PGY-3, PGY-4 and PGY-5 Chief Resident levels, there are generally 9 categorical residents. All members of the house-staff hold academic appointments as Clinical Fellows in Surgery at Harvard Medical School.
The surgical training program produces the country’s future surgical leaders. Clinical excellence is the foundation upon which that leadership is built, and our training programs endeavor to help young surgeons develop both technical and cognitive expertise. At all levels, the housestaff enjoy the training and practical experience in the preoperative, operative, and post-operative care of patients.
The Beth Israel Deaconess program emphasizes resident-faculty interaction for educational purposes. Teaching conferences and seminars for the housestaff capitalize on working relationships developed with the attending staff.
Upon completion of five years of surgical training, residents are eligible for the American Board of Surgery Examination. Outstanding specialty fellowships in plastic, cardiothoracic, pediatric, transplant, colorectal, and vascular surgery are obtained routinely by our graduates. Graduates typically enjoy superb opportunities in either private or academic practice.
Carl J. Shapiro Simulation and Skills Center
The Carl J. Shapiro Simulation and Skills Center (SASC) at Beth Israel Deaconess Medical Center (BIDMC) offers the latest advances in medical simulation technology to BIDMC, neighboring institutions and the global healthcare field in a new, state-of-the-art facility. The Center provides realistic training opportunities for learners at all levels, from all disciplines, and uses progressive teaching methods to replicate real-life patient care situations, from routine procedures to acute management crises.
The SASC raises the bar for major academic medical centers by providing health care students and professionals with curricula and skills training on the latest medical and surgical techniques in a state-of-the-art, technologically advanced facility. Although most health centers offer some degree of medical simulation training, the scale and scope of BIDMC’s SASC make it one of the most comprehensive simulation training centers in the country. The Center includes a large teleconference room for up to 65 learners and contains live media feeds to four different operating room endosuites, allowing for teleproctoring, inter-institutional courses, and intercontinental broadcasting of Grand Rounds. The high fidelity mock operating and intensive care unit rooms used for full-body simulation feature working water and gas lines, video cameras and observation windows with state-of-the-art teleconferencing ability. Two skills lab areas are dedicated to providing learners with hands-on training for basic clinical procedures, open surgical skills, endoscopic, ultra-sonography, and laparoscopic skills with over 30 partial task trainers and high-fidelity procedural simulators.
BIDMC’s Carl J. Shapiro Simulation and Skills Center has been formally accredited as a Level 1 facility by the American College of Surgeons (ACS), the first in Boston and New England – and one of only seven inaugural certified centers in the United States – to provide simulation-based skills training to health care students and professionals from all medical and surgical disciplines.
As an ACS Accredited Education Institute, the SASC is part of the ACS’ developing network of regional education facilities designed to “specifically address the teaching, learning and assessment of technical skills using state-of-the-art educational methods and cutting-edge technology.” This latest accreditation follows the Center’s recent certification as one of 11 national test sites for Fundamentals of Laparoscopic Surgery (FLS) candidates. SASC faculty proctor the two-part cognitive and manual skills exam for residents, fellows and surgeons performing laparoscopic surgery.
Pgy-1 Year
The internship year focuses on the acquisition of basic principles and clinical skills in general and vascular surgery; additional rotations in the Emergency Department and subspecialty services round out the first year experience. The majority of these rotations are at Beth Israel Deaconess Medical Center, supplemented by community-based experience at Mount Auburn Hospital and St. Vincent Hospital, and pediatric experience at Children’s Hospital. Pre- and post-operative patient care is emphasized under the guidance of the attending surgeons and resident staff. Interns participate in those procedures appropriate for their stage of training and can expect to perform pproximately 100 major and minor cases.
Pgy-2 through Pgy-4
The second and third years of residency include longer rotations to provide more in-depth training in general surgery, thoracic and trauma surgery, as well as in critical care and endoscopy. In the fourth year, senior level experience is obtained in general surgery, vascular, transplant and pediatric surgery.
Chief Residency
During the fifth year of training, chief residents hone their clinical skills, performing an average of over 225 cases as surgeon in their final year. Also in their chief year, residents are encouraged to develop their administrative and teaching skills by leading didactic sessions, heading inpatient teams and teaching junior residents. One Chief Resident is selected annually to serve as administrative chief, and also serves as resident representative to the House Staff Education Committee.
While most of the residency years are spent at the Beth Israel Deaconess Medical Center, that experience is rounded out with an excellent community based experience at outside rotations at nearby hospitals:
Cambridge Hospital & Health Alliance
The Cambridge Hospital is a 169-bed, municipal acute care hospital, located in Cambridge. Inpatient services include medicine, surgery, obstetrics, gynecology, psychiatry, and substance abuse programs. An extensive ambulatory care division offers medical/ surgical and psychiatric emergency rooms, a Level 2 trauma center, a primary care center, and more than 25 specialty clinics. The hospital has an emphasis on outpatient care with a high degree of autonomy for trainees. General surgery residents assigned to the Cambridge Hospital gain experience dealing with the serious surgical problems in an urban hospital with a diverse patient population.
Children’s Hospital Boston
Caring for an average of 7,000 outpatient visits annually and performing more than 4,000 operative procedures each year, Children’s Hospital Boston is the largest pediatric hospital in the United States, and one of the largest pediatric surgery programs in the world. The Department of Surgery is a prime reason for Children’s Hospital Boston being rated the best pediatric hospital in the United States for sixteen straight years by a nationwide survey of physicians conducted by U.S. News & World Report. Children’s Hospital’s Department of Surgery provides general and specialized surgical services to infants, children, and adolescents suffering from a wide range of congenital and acquired conditions. Rotations at Children’s Hospital in their first and fourth years offer surgical residents from Beth Israel Deaconess Medical Center a concentrated experience in pediatric and adolescent surgery. Opportunities are available to gain additional clinical or research experience at Children’s during elective periods.
Mount Auburn Hospital
Mount Auburn Hospital, located less than a mile from Harvard Square in Cambridge, is an acute-care, Harvard-affiliated community teaching hospital serving the healthcare needs of residents in Boston’s northern and western suburbs. The hospital offers comprehensive inpatient and outpatient medical, surgical, obstetrical, and psychiatric services and is a leading provider of advanced, specialized care in cardiology, cardiac surgery, oncology, orthopedics, neurology, and vascular surgery. The hospital has a strong surgical orientation, and all specialties are represented. The surgical staff is Harvard-affiliated at all levels, and the hospital has a large, fully approved Harvard medical residency program, as well as a fully approved radiology residency program.
Saint Vincent Hospital, Worcester
Saint Vincent Hospital, a 348-bed acute care hospital located in the new Worcester Medical Center in Worcester, Massachusetts, has a long standing reputation for providing quality care for the patients of Central Massachusetts. The Surgical Department includes general surgery, as well as the subspecialties of vascular surgery, cardiothoracic surgery, neurosurgery, plastic surgery, ophthalmology, otolaryngology, urology and oral surgery. There is substantial complexity including hepatobiliary and pancreatic procedures, esophageal procedures, and complex gastric procedures, abdominoperineal resections, and open vascular and thoracic procedures for trainees at the chief resident level. The rotation at Saint Vincent is popular for caseload, teaching, and the housing provided – replete with a pool and weekly maid service.
Beth Israel Deaconess Hospital-Needham
Beth Israel Deaconess Hospital-Needham is a small, acute care community hospital that has served the residents of Needham and surrounding communities continuously for more than 80 years. The Hospital provides outpatient and inpatient services, complete diagnostic facilities and a full-service emergency department. BID-Needham’s inpatient facilities include medical/surgical beds and a seven-bed intensive and cardiac care unit. Inpatient surgical services include orthopedic procedures and implants, urological, vascular, thoracic, plastic, reconstructive, endoscopy, gastrointestinal, general surgical and gynecological procedures. This one-month preceptorship gives the mid-level resident a unique window through which to view the practice of community general surgery, offering a broad exposure in all venues – from evaluation in the emergency room, to the operating room and SICU, to postoperative follow-up in the clinic. Residents also obtain additional experience in upper and lower endoscopy.
Didactic Teaching
The program has dedicated education time, including a strong didactic conference schedule, to provide a basic foundation of surgical knowledge and skills.
Required weekly conferences include:
- Mondays: Resident Curriculum Conference / MIS Skills Lab
- Wednesdays: Surgical Service Morbidity/Mortality & Surgical Grand Rounds
- Thursdays: Combined GI Conference
Throughout training, a primary responsibility of senior residents is teaching more junior residents and the students on their service. They are also responsible for the assignment of cases, clinical supervision of medical students and residents, and preparing material for service and teaching conferences.
