• NYPH
• CU Med Center
• Columbia Univ
• Dept of Surgery

• FAQ
• Site Map

• Home
  • A Brief History
  • Dept Highlights
  • From the Chiefs
  • From the Director
• Applying
  • Contact Info
  • Eligibility
  • Travel Info
• The Program
  • Clinical Years
  • Education
  • Research Year(s)
  • International
  • The Hospitals
  • Salary/Benefits
  • Living in NYC
• The Residents
  • Current Residents
  • Graduates
• Subspecialties
  • Breast
  • Cardiac
  • Colorectal
  • Endocrine
  • General
  • Kidney
  • Liver
  • Minimal Access
  • Obesity
  • Pancreas
  • Pediatrics
  • Plastics
  • Surgical Oncology
  • Thoracic
  • Transplant
  • Vascular
  • Wound Healing
• Other Sites
• FAQ

Clinical Experience

Introduction

The program in general surgery involves five years of clinical training. This training occurs primarily at three clinical sites: Columbia-Presbyterian Medical Center, the Allen Pavilion Hospital, and Overlook Hospital (third year residents also rotate through the trauma service at University Hospital in Newark). This provides a diverse experience ranging from a community hospital in a suburban community through a small urban hospital servicing an elderly population to an inner-city quaternary care center.

Throughout the residency, emphasis is placed on the development of operative skills through a high volume of operative procedures as well as the gradual development of independent decision-making both in perioperative and operative care.

Summary of Rotations

[Back to Top]

Internship - PGY1

During their first post-graduate year at Columbia, residents are exposed to a broad range of surgical patients, both general surgery and a variety of surgical subspecialties.
Through exposure to patients on the ward, in the surgical clinics, and in the operating room, interns focus on learning the clinical care of pre- and post-operative surgical patients, and begin to develop surgical skills through the completion of basic operative cases. Education conferences are held throughout the week to provide a didactic counterpart to the extensive clinical exposure.
In addition to the experience on the floor, one month is spent in the surgical ICU; this provides an opportunity to take care of critically ill patients under the direct supervision of senior surgical residents or anesthesia fellows. This first exposure to the management of complex postoperative patients provides an important base for the more independent work in ICU which begins in the second year. Additionally, ample time is dedicated to the operating room performing junior level cases, such as appendectomies, breast surgeries, and other various procedures. Categorical residents generally log 200 cases or so during their intern year.
Each year, seven interns are accepted in the categorical surgical training program, they are joined by varying numbers of other interns both in the preliminary general surgery track and from other subspecialties (including neurosurgery, urology, orthopedics and oral surgery).
In the past few years, as Columbia has adjusted to the new work hours regulation (from the ACGME), physician extenders have joined the residents in caring for the surgical patients, and multiple efforts have been made to free interns from work unrelated to their education.

[Back to Top]

Junior Residency - PGY2 & PGY3

Rotations during the PGY2 and PGY3 year emphasize the management of critically ill patients and the development of skills in the diagnosis and management of surgical diseases.
Residents rotate through the cardiac surgery intensive care unit, and on all other rotations are primarily responsible for following and managing patients in the ICU on each service. Residents rotate through core general surgery services at the Allen Pavilion, Columbia-Presbyterian and Overlook, as well as receiving exposure to subspecialties including transplant and thoracic surgery. These rotations also provide a more substantial general surgery operating experience, consisting of biliary surgery, vascular surgery, colorectal surgery, laparoscopic surgery, and oncology surgery. Residents spend approximately half of year on services with heavy operative demands. Typical caseloads include laparoscopic cholecystectomies, AV fistulas, open colectomies (right and left), and laparoscopic R hemicolectomies. Running a service at an early stage in residency, in conjunction with a senior resident, is the hallmark of our program.
Much of the remainder of these years is spent on the surgical consult service, where the junior resident learns to assess surgical disease in patients both in the emergency room and already admitted to the hospital by another service.

[Back to Top]

Senior Residency - PGY4

The PGY4 year consists of rotations through the core general and vascular surgery services. These include a rotation as chief resident at Overlook Hospital, as well as senior resident rotations through the Allen Pavilion and general and vascular surgery at Columbia-Presbyterian. As senior resident, the PGY4 takes on increasing responsibility for the day-to-day management of patients on the surgical service as well as teaching of junior residents and medical students. In addition this is the beginning of the intensive and progressively more independent operative experience which culminates in the chief residency. Operative experience includes all levels of vascular and general surgery.
An elective rotation is available at both the PGY4 and PGY5 levels. The PGY4 elective rotation provides the opportunity to work in the resident's intended area of specialization developing specialized skills or performing research. Research electives at an outside institution are a possibility with approval during the PGY4 year only.

[Back to Top]

Chief Residency - PGY5

During the final year of training, the chief resident rotates through the various general surgery services at the Allen Pavilion and Columbia-Presbyterian. During this time, the resident is responsible for all aspects of patient care on his or her service. Emphasis is placed on independent diagnosis and operative treatment of surgical patients. An extraordinary range of operative procedures are performed from simple general surgery cases to complex hepatic or pancreatic reconstructions. A tremendous amount of autonomy, and thus responsibility, is granted to the chief resident, in both the operating room as well as with clinical management of patients.
Over the past few years an increasing amount of flexibility has been built into the chief residency year. In addition to an elective rotation in which residents may develop skills specific to their chosen subspeciality, the chief residents have been able to personalize their sequence and type of rotations to correspond with their interests/future career plans.

[Back to Top]

Operative Experience

The chief residents graduate with approximately 1200-1500 cases; we exceed most of the ACGME requirements by wide margins. Recently a large number of new faculty members in colo-rectal, minimal access, oncological and hepatobiliary surgery have been added to the faculty resulting in even further improvement (both in numbers and breadth) in the operative experience.  As a benchmark, a graduating resident typically performs 20-25 Whipple operations as Surgeon Chief during a 7 week hepatobiliary rotation. 

[Back to Top]

Continuity of Care/Clinic Experience

Columbia-Presbyterian has a large clinic population cared for by the resident staff under the supervision of faculty members. In order to facilitate continuity of care and allow residents to organize and participate in the pre-, peri-, and postoperative care of the same patient, clinics are divided by service. Historically, each service has a clinic day when patients were seen by the service. Howver, in the interest of standardizing the outpatient managment of patients, most patients are now seen in the doctor's private offices. Residents spend time in these offices (which are conveniently located in the Irving Pavilion attached to Milstein Hospital) and participate in the pre- and post-operative care provided in that setting. In addition the Allen general surgery service continues to provide surgical follow-up in the Vanderbilt Clinics each Wednesday.

[Back to Top]

Work Hours

At Columbia-Presbyterian, we are fully committed to honoring the work hour regulations as set forth by the ACGME.  These regulations mandate a maximum of 80 work hours per work over a 4 week period, with 24 hours off per work.  We have an elaborate night float/day care system that allows minimal call for primary care teams, that allows the best experience without the burden of excessive night or weekend call, and a short term night/consult team (Acute Care Surgery team), that take care of acute surgical issues, consults, night call, etc.  The result of these changes has been a reduction of call, improvement of satisfaction of day rotations, and maximization of current resident resources to allow educational learning.  In addition, each service has been staffed with physician assistants or nurse practitioners (sometimes multiple) that fully free junior residents from non-education administrative work (discharge, social work, etc.).  These services have been well-received and are ever expanding.

[Back to Top]