Residency Training

Positions Available
 

Five positions are available at the R1 level.

Three categorical positions are available for trainees interested in completing training in general surgery. Appointment to a categorical position presumes that the appointee will complete the entire five years of general surgery training, with promotion being based on satisfactory performance in the training program.

Two positions are also available for preliminary training spots of one-year or two-year duration for those individuals seeking general surgery training prior to further training in surgery specialty areas. The preliminary program is fully integrated into the general surgery residency. These positions offer a broad exposure to general surgery and surgical subspecialty areas. The rotations are meant to provide a broad background for a candidate interested in surgical subspecialty training.

The categorical positions are matched through the NRMP number 1755440CO. The two preliminary positions are matched through NRMP number 1755440PO.

The content of the various years is as follows:

(Some variation in surgical specialty rotations is possible depending on the specific interests of the individual.)

Vascular surgery, colorectal surgery, thoracic surgery and transplant surgery are all included within the general surgery rotations. The trauma rotations are at Harborview Medical Center, which is part of the University of Washington system and is the designated regional trauma center. One month of Trauma, one month in the Emergency Room, and one month of Burns/Plastics during the R1 year, along with two months in Trauma in the R2 year, and three months of Trauma in the R3 year are spent at Harborview Medical Center.  One Pediatric Surgery rotation is at Childrens’ Hospital in the R2 year.

Teaching Faculty
 

The responsibility for teaching is assigned to selected members of the surgical staff. Selection is based on demonstrated teaching ability and willingness to delegate appropriate responsibility for patient care to residents. Faculty appointments are reviewed annually. Reappointment is dependent upon satisfactory performance.

The voluntary, full-time attending surgery faculty is comprised of 36 general surgeons who assume the responsibility for resident instruction and supervision. They also serve on the Surgery Residency Advisory Committee which meets monthly with the Surgery Residency Program Director. In addition, they serve in an advisory capacity for change proposals within the residency program. These faculty members are divided into five surgical teams, representing areas of subspecialty interests and practice groups. The surgical staff is highly qualified and their range of interest and capability spans the broad field of general surgery, including newer areas such as laparoscopic surgery and minimally invasive surgery techniques. An equally strong staff exists in surgical subspecialties and non-surgical fields. The residents also constitute an important part of the faculty, with resident-to-resident instruction an integral part of the program.

Patient Spectrum
Most patients admitted to the hospital are private patients of the medical staff. The patients’ care, including operative procedures, is shared with the resident staff.

Organization of the Surgical Service - Assignment of Residents
For teaching purposes, the general surgical service is divided into five teams under the supervision of the chief residents. In this organizational model, each surgery resident is assigned as an individual on each rotation to interact closely with a small group of surgical attendings, both on the general surgical service and on the surgical subspecialties. Residents are not assigned to resident teams. The surgery resident is solely responsible for the care of each of his attending surgeons’ hospital patients in the pre-operative, intra-operative and post-operative setting under the direct supervision and instruction of the attending surgeon. Likewise, the surgery resident participates in the outpatient office setting with his attending surgeons for the pre-operative evaluation and post-operative management of the patients. In this way the educational emphasis is on a one-on-one tutorial relationship with clear and direct lines of responsibility and supervision from attending surgeon to the individual resident rotating on his service. At the chief resident level, the chief resident works with half of the attending surgeons on six-month rotations and is directly responsible to each attending surgeon while supervising the junior residents under those attending surgeons’ responsibility.

Intensive Care Unit experience is received starting in the first year of training on a day-to-day basis within the regular resident rotations. Residents follow their own individual patients within the ICU, allowing them extensive experience in the care of the Intensive Care Unit patient throughout the training period. Additional experience in the Intensive Care Unit is obtained during the second-year rotation at Harborview Medical Center in the Trauma ICU.

In-house, on-call rotation is every fourth night in virtually all rotations. Each resident is expected to have completed all work assignments and to have stabilized all patients before signing out.

Elective rotations are normally available in the third or fourth years.

In addition to the private service, there is a House Service consisting of patients who need financial assistance. Both inpatient and outpatient care is provided by the house staff under the supervision of an assigned staff member. Patients may be self- or physician-referred.

The hospital Emergency Services Department provides care for patients of the hospital staff and for a significant volume of walk-in patients. The facility is staffed by full-time emergency physicians as well as house staff.

Patient Volume
Swedish Medical Center/First Hill is a fully accredited acute-care, general hospital with 697 licensed beds that serves as a primary-care facility for its staff and a secondary and tertiary-care referral center for the region. Hospital occupancy is consistently greater than 70 percent with 28,202 inpatient admits and 260,152 outpatient visits at the First Hill campus in 2000. (Surgery residents only work at the First Hill campus.) A total of 26,860 surgical procedures were carried out in 2001. Surgical facilities include 20 inpatient surgical suites, 10 ambulatory surgical suites and a state-of-the-art eye surgery center.

In 2001 more than 3,000 patients were seen in the emergency facility each month. It is significant that approximately 21.5 percent of these patients were admitted to the hospital, an indication of the severity of these patients’ illnesses.

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