Rotations During Training
The Core General Surgery Residency: Anyone contemplating interviewing at Stanford and becoming part of this training program will want to know something about the rotations during their five clinical years of training. We have chosen to divide the residency into two components; the Core General Surgery Residency and the Senior General Surgery Training Program. At Stanford, the six categorical General Surgery residents are joined by up to five preliminary residents who are entering fields such as Interventional Radiology, Anesthesiology, etc., as well as seven first year Orthopedic residents, three first year Plastic Surgery residents, three Urology residents, four Otolaryngology/Head and Neck residents , two Cardiothoracic residents, and one Vascular resident. Thus, in the first postgraduate year there are a total of 31 interns at Stanford. In the second year of training there are at least 15 residents and occasionally 17 or 18, consisting of the six categorical General Surgery residents, the three Plastic Surgery residents, three Urology residents, two Cardiothoracic residents, 1 Vascular, and occasionally two or three individuals seeking a second year of training before going into a different subspecialty. These residents are considered to be part of the Core General Surgery Residency.
The assignments of residents are driven by a core curriculum and by the special requirements of the Residency Review Committee. A representative sample of rotations follows this brief narrative description. The goal of the Core General Surgery Residency is to provide residents with graduated responsibilities in the primary components of General Surgery. In addition, it will give them an appropriate experience in subspecialties required by the Residency Review Committee. It is extremely important to point out that during these first two years the residents do a large number of operations under the direct supervision of a faculty attending or in some cases, a senior surgical resident. Our interns and second year residents perform as many as 100-200 cases per year during this time.
Resident Rotations By Year
We have established a relationship with the University of Zimbabwe Hospital that has resulted in what we believe to be an extremely productive educational experience for our surgical residents.
International rotations in resource constrained environment offer a rich opportunity for personal and professional growth of the surgical resident. Zimbabwe is a low income country emerging from an economically challenged decade where the basic medical education structure of the country was severely impacted. The University of Zimbabwe is the only medical school in the country and offers certified training programs in general surgery, orthopedics, and pediatric surgery. The hospital is the trauma center and tertiary referral center for the entire country. There are 13 surgical faculty with the academic and program leadership being led by Professor Godfrey Muguti, FRCS. Stanford surgical residents will rotate on the general surgery ward as a house officer. They will have the opportunity to evaluate and treat a wide variety of diseases in various stages of presentations. In general patients present with later stage disease than in the US due to access to care issues. Residents will have to perform patient workups and do clinical decision making without access to the specialized radiologic testing they have become accustomed to in the US. Importantly they will interact professionally with a culturally different set of residents, attendings, and patients. They will serve as educators for the medical students on service and the more junior residents in basic surgical skills such as suturing and knot tying. The advantages of this experience are the opportunity to be intensely exposed to a different system of health care in an economically challenged and resource-constrained environment. We believe that their clinical decision making and physical exam skills will improve and their understanding of cultural competency could only be increased. We also expect them to serve as ambassadors of US surgery and educators of other trainees where appropriate.
Residents participating in this rotation will be supervised on site by Professor Godfrey Muguti, FRCS, University of Zimbabwe, and at Stanford by International Rotation Director Dr. Sherry Wren.
Description of the Clinical Experience:
● Type of center: governmental tertiary referral university health care system
● Scope of practice of the host center: Hospital is the referral hospital for all complex surgical care in Zimbabwe and performs has General, Neurosurgery, Urology, ENT, and Orthopedics services. Surgeons do all of the endoscopy in the hospital.
● A statement of the center’s operative volume and type: Hospital has 12 operating rooms daily.
● A statement about the adequacy (or not) of the supportive anesthetic, radiology, laboratory, and critical care infrastructure. Trained anesthesia physicians are present in the OR for all cases, basic radiology services of plain x-ray are routinely available. Advanced imaging such as CT or US is occasionally available. Basic laboratory services are available.
● Verification that the experience will include an out-patient experience: Residents will attend clinic with the general surgery team in the hospital.
● Verification that the resident will enter operative experiences for credit: Residents will enter cases via the web based case log system.
On-Call and Work Hours
The Training Program at Stanford is dedicated to developing a call schedule whose goal is consistent with the core curriculum, not with service that makes learning difficult or in some cases impossible. We have committed ourselves to following the ACGME work hour rules.