Surgery Rotations

surgeryrotationThe Residency Review Committee (RRC) for General Surgery of the Accreditation Council for Graduate Medical Education (ACGME) has approved the Program for ten categorical positions, two at each level, and a single provisional PGY1 position.

The Program has four key goals:

  1. To produce caring and skilled general surgeons who are able to pass qualifying and certifying examinations as per the American Board of Surgery (ABS), and who are able to begin the practice of general surgery in any type of practice environment;
  2. To insure that residents who seek post graduate training in any specialty will be sufficiently prepared and supported to accomplish that goal;
  3. To train residents in general surgery using educational curricula congruent with that espoused by the American College of Surgeons, RRC, ACGME and ABS;
  4. To create an environment conducive to optimal learning and achievement of each resident's personal and professional goals.

The overall mission is the comprehensive professional education of the surgical resident. The absence of fellowship programs enables a broad general and surgical specialty experience. NHRMC resident caseloads and variety are monitored to insure appropriate exposure to the full spectrum of general surgery and compliance with ABS expectations. 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 successfully complete the program and pass both parts of the General Surgery board examination. Approximately 64% of graduating residents (29 of 46) since 1987 have completed or entered fellowship training in a surgical subspecialty, all at university programs.

First Year

The educational emphasis is 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 exposure to neurosurgical and orthopedic trauma enables early competence in the assessment and management of the multiply injured patient. An additional four months are spent with two affiliated community practices, Wilmington Health Associates and Coastal Surgical Specialists, who offer in depth exposure to elective and emergency general surgery as well as specialty surgery. Two months are committed to a "float" general surgical rotation, wherein one is 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 care, substantial participation in operative surgery is provided.

Second Year

The second year serves to further develop one's general surgical armamentarium. The resident will spend one-month on a critical care rotation where the fundamentals of critical care diagnosis and management are taught on a daily basis. Substantive experience is gained in the operating suites learning the basic elements of operative therapy as seven months are 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, neuromuscular blockers, and sedatives. A one month rotation in plastic surgery serves as an advanced course in wound management, reconstructive surgery, free flaps, and cosmetic operations. Second year residents will spend four weeks at UNC Chapel Hill, with two weeks each devoted to the Burn Center and the Transplantation Service.

Third Year

The resident begins senior-level responsibility as the most senior in-house resident at night and on weekends. The PGY-3 is responsible for initiating trauma resuscitations and seeing all consultations and acute surgical admissions for the teaching faculty, assisting with operative cases as directed by the Chief Surgical Resident, and managing patients in the Surgical Trauma ICU. The latter occurs in the context of a six month rotation. A one month Cardiothoracic rotation follows the STICU experience.

Fourth Year

Decision-making and operative responsibility hallmark the fourth year which is entirely dedicated to, general surgical rotations. As the most senior resident on the service for six months, responsibilities comparable to a Chief Resident characterize the experience. Progressive autonomy in service management and inter-personal skill development through serving as a liaison between the resident and attending staff are what distinguishes the PGY-4 year. The operative and clinical experience is rich and of unlimited value for assumption of the Chief Surgical Resident (CSR) role.

Fifth Year

The final year finds the CSR fully responsible for one of the three general surgery services and serving as the administrative and professional leader of the service. The CSR participates in a broad variety of operative surgery with emphasis on complex cases. Complex cases come under the categories of major abdominal, thoracic and vascular trauma, advanced laparoscopic surgery, hepatic and pancreatic surgery, and complex thoracic and endovascular and open operations. Operative volumes and case mix readily exceed minimal ABS requirements. Call is taken from home with the expectation that an in-house requirement can be easily for appropriate clinical situations. This year most reflects and simulates the life of a practicing community surgeon.


Productivity in clinical research is an educational priority. The mission of the Research Department at SEAHEC is to support resident research. It is staffed by three, highly qualified, full time personnel under the leadership of Dr. Kris Walters.

Selection of a research project starts with the proposal of a research question usually generated from the experience and interest of the resident. The resident selects a member of the attending staff to assist with the project. Collaboration between private and core faculty in conjunction with the Research Staff enables projects to come to fruition on schedules consistent with residency demands. Extensive literature reviews emphasize the principles of critical data evaluation and relevant statistical analysis. The Research Department assists with research design and data base construction, application of statistical tools, and data interpretation. Residents, Faculty, and Research Staff meet on a monthly basis to review the progress of on-going projects and to entertain new ideas as proposed by resident researchers. All primary research methodology is taught by members of the Research Staff on an annual basis. Research findings are reported at the Annual Research Forum every October. Residents have regularly presented their findings at regional, state, and national meetings. Publications in peer-reviewed journals enhance the applications of residents pursuing post graduate training and stimulate interest in new projects, optimizing outcomes and developing new models of care.


Faculty continually evaluates resident clinical performance and professional progress under the auspices of the Surgery Graduate Medical Education Committee. The committee is composed of full time and community faculty as well as CSR's. The Program Director meets with each resident on a semi-annual basis to provide formal feedback and guidance and to illicit feedback from the resident relative to the operation of the residency program in fulfilling its mission. A commonly noted advantage of small residency programs is the opportunity for residents to interact with faculty on a daily basis and who are readily available on an around the clock basis.

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 resident education and progress may continue unabated. 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 a situation for which resources other than faculty are desired.