university of california, irvine general surgery residency … general surgery 2013.fi… · ·...

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University of California, Irvine General Surgery Residency Program

Entering Class of 2013


General Surgery Residency

• Program Director Matthew Dolich, MD

• Director of Surgical Education Jill Endres, MD

• Asst. Program Director Brian Smith, MD

• Residency Coordinator Tania Saba Brigette Yzaguirre – Asst.

Chair : Michael J. Stamos, MD


Interview Day

Who are we?

What’s our commitment?

What’s it like to train here?


Our Setting

New Hospital Opened March 2009


Basics• Orange County

Population - 3 million Catchment area - > 5 million

• UC Irvine Sole university medical center

• Department of Surgery 47 years old

• Residency program New program expansion to 6 categorical / 4 prelim

residents per year Fully accredited by ACGME, next accreditation visit in

2014


Surgeon of the Future• Lead safe high performance teams

Integration of surgical/nonsurgical skills

• Evidence-based practice• Outcomes data – measurable• Continuous, professional development• Maintenance of certification based on

practice• Communication, respect for others


GeneralSurgery

Surg Onc Vascular MIS/BariatricCardiac TransplantTrauma/

Burn/CriticalCare/ACS

HepatobiliaryColorectal Pediatric

Department Evolution• Multidisciplinary work groups

Technology – Increasingly ambulatory/minimally invasive

• Disease / mechanism of disease focus


Department Mission

Provide world class surgical care while minimizing the footprint we leave behind


Training Philosophy• Top quality patient care - 1st priority• Attention to individual's needs

Each resident has unique goals Research year(s) is/are optional

• Broad exposure to all surgical specialties• Graduated responsibility• Team approach – work hour compliance• Exposure to all practice types

Academic, private practice, VA, multispecialty HMO


When You See One of Us, You See All of Us


Clinical Sites• Sponsor

University of California, Irvine

• Integrated Veterans Affairs Medical Center, Long Beach

• Affiliated Long Beach Memorial Medical Center Kaiser Anaheim Medical Center Children’s Hospital of Orange County (CHOC)


Clinical Sites - UCI Medical Center


UC Irvine Medical Center

• 424 bed tertiary referral center• Level I Trauma Center & Burn Center• Chao Family Comprehensive Cancer Center• Comprehensive Digestive Disease Center (CDDC)• Comprehensive Cardiovascular Care Center (C4)• Aesthetic Institute and Beckman Laser Institute • ACS Certified Surgical Skills Training Center


UC Irvine Medical Center

• 5,400 ambulatory surgery visits/year

• 5,000 inpatient surgical admissions/year

• ≈ 40,000 Emergency Department visits/year

• 3500 trauma activations/year


Clinical Sites - VA Long Beach


Clinical Sites - LBMMC


Clinical Sites - Kaiser Anaheim


Clinical Sites - CHOC


Surgery Faculty & Divisions


Division of Cardiothoracic Surgery • Jeffrey Milliken, MD – Division Chief• Marvin Kirsh, MD• Joe Carey, MD


Division of Colon & Rectal Surgery• Alessio Pigazzi, MD

Division Chief

• Michael J. Stamos, MD

• Steven Mills, MD

• Joseph Carmichael, MD


Division of Critical Care/Trauma/Acute Care Surgery/Burns

• Michael Lekawa, MD Division Chief

• Cristobal Barrios, MD• Nicole Bernal, MD• Matthew Dolich, MD• Allen Kong, MD• Christopher Lane, MD


Division of Gastrointestinal Surgery

• Ninh Nguyen, MD Division Chief

• Brian Smith, MD


Hepatobiliary & Pancreas Division• David Imagawa, MD, PhD

Division Chief• Brian Smith, MD

• Aram Demirjian, MD


Division of Surgical Oncology• Ninh Nguyen, MD

Division Chief• James Jakowatz, MD • Karen Lane, MD• John Butler, MD• David Hsiang, MD


Division of Plastic Surgery

• Greg Evans, MD Division Chief

• Al Aly, MD• Daniel Jaffurs, MD• Mark Kobayashi, MD• Keyian Paydar, MD• Garrett Wirth, MD


Division of Transplantation• Clarence Foster, MD

Division Chief• Hirohito Ichii, MD• Janette Carbone, PA


Vascular Surgery Division• Roy Fujitani, MD

Division Chief• John Lane III, MD• Mark Smith, MD

• Russell Williams, MD• John E. Connolly, MD• Ian Gordon, MD• Samuel E. Wilson, MD


Beckman Laser Institute

• Bruce J. Tromberg, PhD Director

• Michael Berns, PhD• J. Stuart Nelson, MD• A. Durkin, PhD• V. Ennis-Lamorte, PhD• K. Kelly, PhD• P. Wilder-Smith, PhD• B. Choi, PhD• E. Botvinick


Research Division• Jonathan Lakey, PhD,

Director of Research Pancreatic islet cell

researcher Directs core lab Stem cell therapy

• Earl Steward, Laboratory Manager Backbone of live animal

research and teaching models


Residency Education Division• Michael J. Stamos, MD• Matthew Dolich, MD• Jill Endres, MD• Brian Smith, MD

• Tania Saba Residency Coordinator

• Brigette Yzaguirre Asst. Residency Coordinator

• Damon McCumber Simulation Technician


Surgical Services

• UC Irvine Medical Center

Red - Vascular Blue – Colorectal Green - Hepatobiliary/Pancreas/Transplant White – Surgical Oncology/Breast/CT/

Gastrointestinal/MIS ACS - Trauma/Critical Care/Burn Ortho/ENT/Plastics/Neurosurgery/Urology


Surgical Services

• Veterans Affairs, Long Beach Pink – Vascular Yellow - MIS/GI/Colorectal/Onc/Thoracic

• Long Beach Memorial Medical Center Adult General Surgery

• Kaiser Anaheim Medical Center Adult General Surgery

• CHOC Pediatric Surgery


Flexible Rotation Scheduling

• American Board of Surgery now endorsing flexible rotation scheduling Effective 09/2011

• Allows customized rotation schedule based on planned fellowship or practice

• PGY 3-5 years• Up to 6 months/year, 12 months total


Major Teaching Conferences• Core Conferences – Thursday a.m.

Basic Science Grand Rounds M&M Skills Training/Chair Rounds/Journal Club

• Trauma/Critical Care Core Lecture Series• ACS Case Conference• Burn Journal Club• Multidisciplinary Tumor Board• GI Surgery Conference• Colon and Rectal Multidisciplinary Case Conference• Vascular Case Conference


Operative Case Numbers 2003-2012

• Mean total cases = 950 per resident ACGME “desired” range = 750 – 1000

• Mean total chief cases = 237 per resident ACGME “desired” range = 150 – 300

• Excellent performance in all defined categories


Boards Pass Rates – Last 5 Years(First time takers)


Research Years• Core laboratories

Basic Science• Shock, MIS, GI, oncology, tissue imaging, islet cell

transplantation Clinical Outcomes

• Option for 1 or 2 years of dedicated research, after completion of PGY-3 clinical year


Research Years

• Typically 2-3 residents per class • Intramural (UCI or VA Long Beach)• Extramural• Residents present work at regional,

national, international meetings• Peer-reviewed publications

Surgical Oncology GI/Colorectal

Vascular Trauma/Critical Care


First Jobs- Last 5 Years

Fellowship

Practice

85%15%


Fellowship Destinations• Vascular

Harbor-UCLA, Case Western, Cleveland Clinic, U. of Chicago, SUNY Stony Brook, U of A, UCLA, Baylor, Scripps, UMass, Texas A&M

• CT Surgery UCLA ,UCSF, Emory, Baylor

• Surgical Oncology City of Hope, Moffitt

• Colon and Rectal Surgery Seattle, Baylor, Cook County,

OHSU• Pediatric Surgery

St. Christopher’s• Plastic Surgery

UCI, UCLA, USC, UCSD, Methodist

• MIS UCI, Cleveland Clinic, Univ. of

Wash, Univ. of Florida, Univ. of Pittsburgh, USC

• Critical Care/Trauma Maryland Shock Trauma, Univ.

of Hawaii, UCI, St. Louis University


• Justin Galovich, MD Vascular Fellowship – Harbor UCLA

• Meghann Kaiser, MD Trauma/Crit Care Fellowship – Maryland Shock Trauma

• Boris Borazjani, MD Trauma/Crit Care Fellowship - UCI

• Brian Buchberg, MD Colorectal Fellowship - OHSU

• Erwin Ong, MD General Surgery Practice – Kaiser Permanente

Recent Graduates - 2012


• Joe Chen, MD Plastic Surgery, Methodist Hospital Houston

• Nicole Datrice, MD General Surgery Practice

• Patrick Rudersdorf, MD Cardiothoracic Surgery - UCLA

• Chris Washington, MD General Surgery Practice – Kaiser Permanente Orange County

Current Chief Residents


Fellowships at UC Irvine

• Surgical Critical Care• Colon and Rectal Surgery• Acute Care Surgery• Minimally Invasive Surgery


The Other 88.5 Hours/Week


FAQ’s

• Do I need to come back for a 2nd look?• What post-interview correspondence

should I expect/provide?• What “perks” are offered?

ACS membership, Meals, SCORE, AccessSurgery, ATLS, FLS, Fundamentals of Surgery, meetings for presentations, lab coats


• Decreased work hours• New technology• Outpatient surgery• Patient safety • Simulation and Skills Laboratories

Surgical Education and Skills Training


Protected Conference TimeThursday

6:30 – 10:30 AM

Core Curriculum Morbidity & Mortality

The 4th HourSkills Training

Chief Preop RoundsJournal Club

Grand Rounds

Thursday Educational Conferences


• Two year cycle• ABSITE/Board MCQs• Wireless response system• Interactive format• Learner centered

Core Curriculum Conference


• Integrates Core Competencies Patient Care Systems Based Practice Practice Based Learning and Improvement Professionalism Medical Knowledge Interpersonal and Communication Skills

Grand Rounds/M&M Conference


• Skills Training/Simulation (ACS/APDS Phase I) Basic and Advanced Laparoscopic Skills (FLS) Asepsis and Instrument Identification Central Line and A-line Insertion Chest Tube and Thoracentesis Airway management Colonoscopy Inguinal Anatomy Knot Tying Vascular Anastomosis Laparotomy Suturing Upper Endoscopy Hand-Sewn Gastrointestinal Anastomosis Stapled Gastrointestinal Anastomosis

“The 4th Hour”


• Intro to ATLS• Task Training Workshop

Chest Tubes/Thoracentesis Intubation/Cricothyrotomy A-Lines

• Bedside US/FAST Exam• Central Line Insertion• Cadaver Lab

Chest Tubes/Airway Thoracotomy

• Hernia Lab• Patient Handoff Workshop• Professionalism/Ethics

Intern Boot Camp 2012


UCI Surgical Education Center - Orange


UCI Medical Education Building - Irvine


• Low fidelity trainers Partial task trainers

• Standardized Patients

• High fidelity mannequins

• Screen Based Simulation

Medical Education Simulation Center


• Skills Training/Simulation – UCI Skills Curriculum Bedside Ultrasound Robotic Education Labs Suture/Needle Workshop Transoral Incisionless Fundoplication (TIF) Cadaver Labs

• Advanced Thoracic Anatomy• Upper Extremity/Neck Exposure• Fasciotomy• Pericardial Window• Cricothyrotomy• Popliteal exposure• Axillary dissection

Dedicated Surgery Simulation Technician – Damon McCumber• 1:1 Laparoscopic Surgery Labs

– Laparoscopic Exploration, Appendectomy, Splenectomy, Paraesophageal Hernia Repair, Nissen Fundoplication, Right hemicolectomy

“The 4th Hour”


Virtual Reality Training at UCIWhat’s Next?

ROSS®

MIMIC®

DaVinci®


Virtual Reality Training at UCIWhat’s Next?

SonoSim®

LapSim®


Virtual Reality Training at UCI

• EndoSim® Endoscopy Simulator


• Chief Preop Rounds Preop, Intraop, Postop decision making skills

• Journal Club• CC Conferences

Professionalism, Disclosing Error, Patient Handoff, Communication

• Resident Town Hall• Practice Management Topics

Private Practice, HMO, Labor Law, Billing/Contracts, Malpractice Insurance

“The 4th Hour”


• PGY-1 Fundamentals of Surgery Curriculum

• Quarterly Education Mornings Mock Orals MedEd Mornings – Team Training Focused Skills Workshops

• Semi-annually Resident MIS Courses (full day)

• FLS Designated Training Center• OR Simulation/Warmup Room

Surgical Education


• Robust education program• Learner-centered and driven• Multiple educational methods• Active learning• Integrating technology• Didactics and Skills Training• Prepare… “The Surgeon of the Future”

Surgical Education


The Future! The Future! • Leadership stability• Departmental investment

Accelerated growth plan

• OR Expansion Additional MIS rooms New Robot (2 in OR and one in lab) Hybrid Endovascular/Cardiac room


Intellect


All fact collectors who have no aim beyond their facts are one-story people

Two-story people compare, reason, generalize, using the labor of fact collectors as their own.

Three-story people idealize, imagine, predict-their best illumination comes through the skylight.

Quotation by Oliver Wendell Holmes


What’s Next?

• Hospital Tours• Lunch with residents and faculty• Interviews


UNIVERSITY of CALIFORNIA IRVINE

university of california, irvine general surgery residency … general surgery 2013.fi… · ·...

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