The Program has four key goals:

• To produce caring and skilled new general surgeons who are able to pass qualifying and certifying examinations of the American Board of Surgery (ABS), and who are able to begin the practice of general surgery in appropriate community practices;
• To prepare selected residents of appropriate motivation, orientation, and skill for subspecialty training;
• To train residents in general surgery using educational criteria that are congruent with the ABS, RRC, and ACGME; and
• To create an environment that is conducive to learning and an atmosphere that is supportive to each resident's personal life and professional goals.

The overall mission is the comprehensive professional education of the surgical resident. There is little dilution of the clinical educational experience. There are no fellowship programs in any surgical subspecialty at NHRMC, so the resident has no competition for clinical case material. Indeed, NHRMC residents are monitored so that their operative caseloads do not exceed RRC guidelines. For a representative operative case log click the appropriate year below. (These are in Adobe Acrobat PDF format. A link to a free download of Adobe Acrobat is below.) For charts that summarize the total operative experience of NHRMC Chief Residents compared with RRC minimums click here:

We expect that all residents will finish his or her chief residency and pass both levels of the General Surgery board examinations. One-half of graduating residents (15 of 29) since 1987 have completed or entered fellowship training in a surgical subspecialty, all at university programs.

First Year

The educational emphasis focuses on mastery of the basic skills of preoperative and postoperative care. Four months with the University Service provides an introduction to trauma and surgical critical care. Substantial interactions in neurosurgery and orthopedics provide important interactions with these specialties in trauma care. An additional four months are spent with two affiliated private practices, Wilmington Health and Coastal Surgical Specialists. Two months are committed to a “float” general surgical rotation, assigned to one of the three services on a week-to-week basis, depending upon vacation and sick-leave contingencies. While the goal is to develop expertise in pre- and post-operative and critical care, the first year resident still receives substantial operative experience. Otolaryngology and urology share a one-month rotation, completing the year.

Second Year

The second year is the prep year for your senior years and exposing you to more critical care cases with a one-month rotation of critical care. Substantive experience in gaining mastery of basic general surgical operations begins in the second year, with seven months spent on general surgical rotations at NHRMC.  A one-month anesthesia rotation provides important exposure to “the other side of the ether screen,” and familiarity with airway management and the use of anesthetic agents, narcotics, paralyzing agents, and sedative-hypnotics. One month of plastic surgery serves as an advanced course in wound management and exposure to other aspects of the specialty, including reconstruction, free flaps, and cosmetic operations. Two months in Chapel Hill at the University of North Carolina Hospitals for one-month rotations in the Burn Center and with the transplantation service there provide necessary exposure to these important sub-specialties.

Third Year

The resident begins senior-level responsibility in the third year, serving as the most senior surgical resident in three important situations. First, he or she is the senior resident on call, responsible for the initial evaluation and resuscitation of trauma admissions, and the first to see acute surgical admissions and consultations to the affiliated surgical services. Second, the third-year resident is often the most senior resident on general surgical services, aside from the chief resident. As a result, he or she is often responsible for covering the senior level cases that the chief resident cannot cover, and the many routine operations that form the basis of an active general surgical practice. The third year residents spend six months managing the surgical/trauma ICU for the housestaff service and the other six months of the year is spent on general surgical rotations. One month with busy cardiothoracic surgeons at NHRMC provides exposure to the important sub-specialty of CT surgery.

Fourth Year

Decision-making and operative responsibility really begin in the fourth year, entirely spent on general surgical rotations. Because the resident is the most senior resident on the service for six months, functionally he or she acts as Chief Resident for these six months. He/she begins to build on responsibility of care of the patients on the service, and acting as a liaison between the resident and attending staff. The operative and clinical experience is still rich when the fourth-year resident acts as a senior resident to the fifth-year Chief Resident during the remaining six months.

Fifth Year

The final year finds the Chief Resident fully in charge of one of the three general surgery services throughout the year, acting as the administrative and professional leader of the service. The chief resident participates in the operations that are appropriate to his or her level of training, with particular emphasis on advanced laparoscopic operations, operations of the liver and pancreas, thoracic operations, and vascular surgery. Numbers of operations at the completion of the residency easily exceed RRC standards. All call is home-call as a Chief Resident and Chief call is set up to mimic how a private general surgeon practices.

Research

Productivity in clinical research is an educational priority. The Research Department at SEAHEC is available to provide necessary support to complete residents' projects.

Selection of a research project starts with the identification of a research question. The resident selects a member of the attending staff to assist with the project. If one of the private attending staff is involved, a member of the teaching staff assists with the progress of the project. A literature review of a given topic reinforces the principles of critical evaluation of the literature. The Research Department assists with database selection, development of clinical research tools, statistical evaluation of results, and interpretation. Presentations are made annually during the Research Forum Day held in October. Several residents have presented their projects at regional and annual professional meetings, and have published their results in peer-reviewed journals.

Oversight

Faculty, both fulltime and private, continually evaluate the residents' clinical performance, education, and progress toward professional goals. Regular meetings of the Graduate Medical Education Committee of the Department of Surgery, made up of the fulltime faculty and representatives from each of the two affiliated private practices provide a synthesis of the resident's progress. The Program Director meets with each resident on a semi-annual basis to provide feedback and guidance on a formal basis. However, a small residency affords many opportunities for informal meetings in offices, in the operating room, the O.R. lounge and elsewhere for the resident to seek out and meet with any surgeon at almost any time.

Problems and difficulties that occur during residency are dealt with in a direct manner, under strict confidence, and with the resident's welfare as the prime objective. Solutions are fashioned with the expectation that nearly any situation can be overcome and the resident's education continued in good time. Residents know that any grievance will be heard and dealt with appropriately. They have recourse to approach the Executive Director of SEAHEC should they encounter any situation that involves faculty or the program director.