Progress ReportReports of the Vice Chairmen

Medical Education
Mark A. Hardy, MD

Mark A. Hardy, MD Vice Chairman Education & Employee Development

Columbia has developed a unique model for physician education. We train residents in the latest surgical techniques, teach them to collaborate with other disciplines, and encourage them to identify treatments that can change the way we practice medicine.

Entrants in our annual Resident Research Competition have explored a solution for cardiac preservation, new ways of tracking outcomes and anti-angiogenesis approaches to solid childhood tumors. Residents have the option of taking a one- to two-year leave, usually on site, to pursue independent research. Most of them take this opportunity and later view it as the cornerstone of their careers.

Our new program in Translational Research also shows residents how to move new surgical advances from the laboratory bench to the clinic, track patients' responses, and make any necessary refinements. As a result, our residents are exposed to virtually every aspect of medical innovation.

In 2004, our resident program expanded by 40 percent. The incoming class benefited from our new endoscopy suite and from a course in image-guided surgery. General surgeons will soon perform many procedures previously considered to be the domain of the interventional radiologist. Therefore the next generation must be proficient in stereotactic needle biopsy, percutaneous drainage of abscesses, stent insertions, radio-isotope and ultrasound localizations.

The Department of Surgery recently developed a new web-based simulation to teach new minimal access operations. Our residents also become familiar with robotic techniques, pioneered by our surgeons.

In the past five years, we have made important changes in our curriculum. With the new emphasis on shorter hospital stays, residents have fewer opportunities to interact with patients. So we have reorganized our specialty clinics, allowing residents to work in physicians' offices, and to assess patients both before and after surgery.

To prepare our students for the financial and organizational challenges of private practice, we offer seminars on office management, personnel, ethical dilemmas and medical-legal issues, job interviews, long-range career planning, pensions, insurance, and reduction of medical errors.

In our formal Mentorship Program, experienced surgeons share their knowledge with residents, helping them to secure distinguished fellowships and key research positions. In 2004, our department had the greatest competition in the nation for its eight different fellowships.

Columbia residents are also encouraged to mentor one another. One of our chief residents organized a lecture series to help young doctors focus on "professional life after the residency". Another recently designed a computer-based method of learning and performance evaluation and introduced this system in Grand Rounds.

A new review program ensures our residents will achieve superior scores on the ABSITE tests. In 2004 one hundred percent of our class passed their qualifying and certifying examinations on their first attempt.

Columbia residents have also responded creatively to the eighty-hour week mandated by the ACGME. Three months after the new regulations went into effect, Columbia achieved 100 percent compliance and set new standards for performance. This was presented to the national meeting of Program Directors and has been used as a model by the ACS.

We reorganized our coverage, creating a day-care system and a night-care system for each service. Under the old system, it was not unusual for a patient to be evaluated by several different physicians. The new system offers more consistency of care: patients are assigned one physician for the morning and another for the evening evaluation. A comprehensive review shows that all groups—patients, nurses, residents, and even residents' spouses—are more satisfied with this approach.

There is no doubt that surgery is undergoing major changes. Our department is providing fresh solutions to old problems on both practical and conceptual levels. This commitment to innovation has allowed us to lead the revolution in surgery today.