Areas of Training

Thoracic and Vascular
Thoracic and vascular surgical experience is gained through specific rotations on panels in which the major surgical area of interest is within these fields.

Trauma
Experience in trauma care is obtained at Harborview Medical Center, a Level I Regional Trauma Center and a University of Washington teaching hospital. Trauma rotations are assigned in the R1, R2 and R3 years.

Burn Care
Burn-care experience is gained during the R1 year during a rotation at the Harborview Medical Center Burn Unit, the regional burn center.

Pediatric
Concentrated pediatric surgical experience is provided during the second year through a rotation at Children’s Hospital Medical Center/Seattle, the Northwest’s regional pediatric medical center. Additional experience is gained by frequent interaction with the pediatric attending surgeons at Swedish /First Hill throughout the five years of the program. This includes experience in the Special Care Nursery, which provides the highest level of neonatal intensive care available in the Northwest. The Medical Center is currently expanding its pediatric services on both an inpatient and out-patient basis.

Plastic Surgery
Plastic and reconstructive surgical experience is obtained during the Burn rotation at Harborview Medical Center's Burn Unit in the first year and during general surgery rotations at Swedish, with a considerable amount of exposure on the Breast and Head & Neck rotations.

Organ Transplantation
The Organ Transplantation Service provides broad clinical experience in the management of kidney and pancreas transplantation. Resident rotations occur in the third and fourth year, and residents are actively involved in the operative procedures, as well as the pre-operative selection and preparation and post-operative immuno-suppression and care of the transplant patient.  The State of Washington has approved a Certificate of Need for Liver Transplantation services at Swedish Medical Center.  The liver transplantation program will be active in 2006.

Endoscopy
Resident experience in endoscopy is obtained through-out the training program, with bronchoscopy experience being obtained on the thoracic surgical rotations. Flexible sigmoidoscopy and colonoscopy experience is obtained during rotations on the colorectal service – normally in the R2, R3 and R4 years. Additionally, a specific one-month rotation on endoscopy is assigned during the R3 year where the resident’s sole responsibility is upper endoscopy.

Head and Neck Surgery
Head and neck surgery experiences are provided through two-month rotations in the second and fourth years.

MIS/Laparoscopic Surgery/New Surgical Techniques and Equipment
Operative experience with minimally invasive surgical techniques is extensive with introduction to these techniques early in the residency. The average chief resident completes the program with more than 200 minimally invasive procedures performed (median average nationally is 95). The majority of this expertise consists of cholecystectomies, anti-reflux procedures and thorascopic procedures. There is opportunity for additional and more advanced procedures.

We have also established a Minimally Invasive Surgery Lab where residents can practice their technique using state-of-the-art equipment at any time. Several times per year our residents are invited to attend MIS/Laparoscopic/Endoscopic workshops sponsored by SAGES. The residency program supports resident attendance at these workshops whenever they are offered.

Breast Surgery
In addition to the exposure to management of benign and malignant breast surgery on the general surgery rotations, two months of the second and one month of the third year is spent entirely devoted to breast disease. Mentored by a surgical oncologist whose practice is limited to the breast, the resident experiences the entire spectrum of this specialty in both the inpatient and outpatient setting with opportunity for pre-operative, intra-operative and post-operative management. There is broad exposure to diagnostic evaluation by mammography and ultrasound as well as image-guided biopsy techniques.

The Business of Medicine
It has become apparent to everyone in medicine today that having good business, marketing and financial management skills is an absolute necessity. We have developed a multilevel, interactive approach to teaching these business skills to our surgery residents. Each year in the early fall, the residents attend a weekend retreat in one of the many relaxing conference facilities available in the area. Invited speakers address different aspects of the business of surgical medicine, including contract law, financial evaluation of a practice, medical staff privileging, malpractice law, personal financial planning, job hunting, contracts, marketing, ethics, etc. The speakers, along with many of the attending surgical teaching staff, then make themselves available for question-and-answer sessions and round-table discussions, providing a springboard for further discussion of these topics on an ongoing basis with the surgical teaching staff. Hopefully, by the end of five years of training, we will have provided the residents a foundation of business knowledge and tools on which to build a successful career.

These retreats also provide an excellent opportunity to relax and socialize outside the work environment with residents, spouses, teaching staff and administrative staff. We have approximately four social events a year and, with every event, the relationships, understanding, communication and respect grow within our program. All of these positive aspects are carried over into the daily activity of resident training.

Other Training Opportunities
Although residents are assigned to specific rotations and are expected to concentrate on that particular specialty, there are many opportunities to expand training. Our radiologists, pathologists, epidemiologists, nephrologists, pulmonologists, and others are always available to teach and consult with the residents. If a resident has a special interest in other types of surgery, such as gynecology, maxillofacial, urology, or orthopedics, they usually find specialists more than willing to have the residents assist in their cases whenever the residents’ schedules allow.

Operative experience upon completion of the program
During the five-year residency period, each resident will perform more than 1,000 cases in a “Primary Surgeon” or “Teaching Assistant” capacity under the supervision of the attending surgical staff. Approximately 500 more cases will be done as a “First Assist” surgeon. Three hundred or more major cases will be performed during the chief residency year. The above information was compiled from reports of chief residents who completed the Surgery Residency Program in 2006. The number of cases performed in each category as Primary Surgeon or Teaching Assistant was averaged in order to provide a picture of a “typical” experience.

Typical Operative Experience:

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