General Surgery

Mission statement

The General Surgery Residency program’s mission is to develop the next generation of physicians and physician leaders. As a part of HCA Healthcare, we are driven by a single mission: Above all else, we are committed to the care and improvement of human life.

This program is designed to offer residents a rewarding, educational environment where residents are provided individualized learning opportunities by faculty and staff who support and sustain one another throughout quality care delivery. Our faculty are committed to ensuring the residents clinical experience and educational needs are fulfilled while expanding residents’ perspectives to be inclusive of cultures, values and ideals.

Salary & Benefits

Year	Salary	On-Call Meals	Total
PGY1	$66,660	$950	$67,610
PGY2	$68,660	$950	$69,610
PGY3	$70,720	$950	$71,670
PGY4	$72,841	$950	$73,791
PGY4	$75,209	$950	$76,159

*Salaries are subject to change.

*$950 will be allotted to each resident for on-call meals.

*New residents will receive up to $1,000 for orientation (if it takes places prior to official employment date).

Health Benefits

• Medical
• Prescription Drugs
• Behavioral Health
• Dental & Vision
• Flexible Spending Accounts
• Life Insurance
• Long-Term Disability Coverage

Finance-related benefits

• HCA 401(k) Plan
• Employee Stock Purchase Plan
• Financial Fitness

Life-related benefits

• Employee Wellbeing Program
• Time Away From Work
• CorePlus Voluntary Benefits (i.e. LifeLock Identity Theft Protection, Legal Benefits, Short-Term Disability, Voluntary Life Insurance, Auto & Home Insurance, Pet Insurance)
• Other Voluntary Benefits (i.e. AirMed Medical Transport, Adoption Assistance, Bright Horizons Family Solutions, Consumer Discounts)

Curriculum and Rotation Schedule

PGY 1 – The PGY-1 year provides early operative experience.

• Residents will establish basic proficiency in the evaluation of patients under routine and emergency circumstances (recognizes surgical emergencies, performs a history and physical examination, orders appropriate basic ancillary studies, effectively communicates findings to faculty and other physicians).
• Will obtain extensive experience in the essentials of pre-operative and post-operative care (writes appropriate pre-op and post-op orders for floor patients, handles nursing calls appropriately, and manages most routine postoperative care with minimal intervention by faculty).
• Develop effective communication skills with patients, families, nursing staff and other medical personnel in order to carry out effective patient care.
• Perform initial evaluation of patient in the outpatient clinic under faculty supervision and communicate this evaluation to the faculty in the clinic.
• Write daily progress notes on their assigned patients reflecting any changes in the patient clinical condition (faculty will read and assess progress notes).
• Assist in trauma codes in the ER and record adequate data of the mechanism of injury.
• Acquire basic operative skills necessary to perform less complex surgical procedures under the complete supervision of the faculty e.g., hernia repair, appendectomy, and drainage of abscess.
• Under complete supervision by faculty, PGY-I residents will perform chest tubes, central lines, A-lines and Swan Ganz catheter. After three successful cases of each supervised procedure, the PGY-I resident may perform these procedures without direct supervision.

PGY-1 Rotation

The Surgical Service at Riverside Community Hospital is divided into the following teaching services:

• 4 blocks (General, Thoracic, Vascular, Surgical Oncology)
• 4 blocks (General, Vascular, and Minimally Invasive Surgery)
• 2 blocks (Trauma, Acute Care Surgery)
• 1 block (Endoscopy)
• 1 block (Ortho/Urology/Elective)
• 1 block (Surgical Critical Care)

PGY 2 – As operative experience increases in the second year, so does clinical responsibility.

• The PGY-2 resident receives extensive experience in surgical critical care. In addition, diagnostic and management skills are further developed.
• Residents are responsible for overall daily care of patients on the service, which is under supervision by faculty or chief residents.
• Obtain work up of all admitted patients to reach the diagnosis. This includes ordering appropriate labs or radiological tests after consulting with faculty.
• Monitor post-operative daily courses of patients. Examine wounds, drain outputs, and abnormal labs or X-rays. Report all their daily findings in their progress notes and immediately to the faculty.
• Perform more operations than the intern under complete supervision by faculty e.g., laparoscopic appendectomy, laparoscopic cholecystectomy.
• Under faculty supervision, follow and accurately assess all ICU patients, learn how to manage ventilation and perform all bedside needed procedures e.g., chest tubes, and A-lines.
• Assist in trauma codes in the ER and perform procedures of ATLS as assigned and privileged.
• Perform pre-operative assessment of all admitted patients and ensure that labs, EKG, and X-rays are available for the operating room.
• All consults are seen by the second year resident and then are presented to the faculty for review. Work up of consult patients starts after faculty has approved.

PGY-2 Rotation

The Surgical Service at Riverside Community Hospital is divided into the following teaching services:

• 2 blocks (General, Thoracic, Vascular, Surgical Oncology)
• 4 blocks (General, Vascular, and Minimally Invasive Surgery)
• 4 blocks (Trauma, Acute Care Surgery)
• 1 block (Surgical Critical Care)
• 1 block (Burns – Arrowhead Regional Medical Center)
• 1 block (Pediatric Surgery – Loma Linda University Medical Center)

PGY 3 – The third year continues development in critical care, with rotations in both the Trauma ICU as well as on the non-trauma Surgical Critical Care service.

• The PGY-3 resident obtains extensive operative experience while managing perioperative issues in close consult with acute care surgery attendings. This early leadership role, accompanied by active mentoring, serves residents extremely well as they continue to progress into the senior levels of residency.
• Residents perform a comprehensive assessment of admitted patients and they develop a management plan to including work up of most surgical diseases. This plan is communicated to the faculty.
• Initiate ATLS protocols in trauma cases seen in the ER and perform necessary procedures on these patients. He/she must communicate with the faculty and work under supervision.
• Assess all ICU patients and master skills in ventilation management, acid base interpretation and correction of imbalances. The third year resident should be familiar with and apply common critical care protocols under faculty supervision.
• Under complete faculty supervision, he/she will perform more surgical procedures to his level of training e.g., bowel resection, basic vascular surgery.
• Evaluate patients in clinics and accurately develop surgical plans for managing these patients. Third year residents should be competent in elective management of most basic surgical diseases. Management plans are then discussed with the supervising faculty.
• Guide and help junior residents in daily rounds and teach ICU protocols.
• Evaluate patients in other services e.g., internal medicine for consults. These consults are then presented to the faculty for discussion of work up.
• Establish a knowledge base, judgment and interpersonal skills necessary to function as a surgical consultant (successfully manages simple consults with minimal help).
• Develop enhanced skills in the management of a surgical service (manages service administrative duties assigned by the faculty).
• Proficiency in the rational use of surgical literature and evidence-based medicine (defends discussions and recommendation with scientific evidence).

PGY-3 Rotation

The Surgical Service at Riverside Community Hospital is divided into the following teaching services:

• 2 blocks (General, Thoracic, Vascular, Surgical Oncology)
• 4 blocks (General, Minimally Invasive Surgery and Bariatric surgery)
• 4 blocks (Vascular, Thoracic Surgery, and Surgical Oncology)

PGY 4 – Continues to develop the knowledge and skills necessary for the complete management of the surgical service.

• Perform complete assessment and management of admitted patients and develops a work up plan for most surgical diseases. This plan is communicated to the faculty.
• Apply ATLS protocols in trauma cases seen in the ER and performs procedures as necessary on these patients. He/she must communicate with the faculty and work under supervision.
• Manage all ICU patients, master and teach skills in ventilation management, inotropic support acid base interpretation and correction of electrolyte imbalances. The fourth-year resident should be familiar with and apply common critical care protocols under faculty supervision.
• Under complete faculty supervision, he/she will perform more surgical procedures to his level of training e.g., advanced laparoscopic, thoracic and vascular surgery cases. He/she will assist in cases that are more complex.
• Evaluate patients in clinics and accurately develop surgical plans for managing these patients. Fourth-year resident should be competent in elective management of most basic surgical diseases. Management plans are then discussed with the supervising faculty.
• Guide and help junior residents in daily rounds and teach ICU protocols for the junior residents.
• Evaluate patients in other services e.g., internal medicine consults. These consults are then presented to the faculty for supervision and discussion of work up.
• The fourth-year resident gradually participates in chief resident call (Home call). During this gradual participation, he/she will work closely with supervising faculty and acts as a chief resident giving him/her early exposure to chief resident responsibilities and experience. The faculty will delegate clinical responsibilities as they judge his/her readiness to do so.

PGY-4 Rotation

The Surgical Service at Riverside Community Hospital is divided into the following teaching services:

• 2 blocks (General, Thoracic, Vascular, Surgical Oncology)
• 4 blocks (General, Minimally Invasive Surgery and Bariatric surgery)
• 4 blocks (Vascular, Thoracic Surgery, and Surgical Oncology)
• 2 blocks (Pediatric Surgery – Loma Linda University Medical Center)
• 2 blocks (Transplant)

PGY-5 Chief Resident – Develops knowledge and skills necessary to assume complete responsibility for the management of the surgical patient, including mastery of the fundamental components of surgery as defined by the American Board of Surgery.

• Proficiency in management of complex problems in general surgery, vascular surgery, surgical oncology and trauma (treats complex problems in the discipline with minimal help).
• Demonstrates personal and professional responsibility, leadership skills and interpersonal skills necessary for independent practice as a specialist in surgery (successfully manages the chief resident services).
• Chief residents in our residency program will function with great independence. As the chief resident of the general surgery service, the resident sees consults, schedules operative procedures, and follows patients post-operatively. This is an invaluable experience and prepares the chief resident to enter into practice seamlessly upon completion of the residency.
• The Chief resident acts as a teaching assistant for all his junior residents in the OR as well as on the floors. He/she performs daily rounds with the team, assigns responsibilities for patient care and review all the clinical work. He/she is responsible for the team management and presents to the supervising faculty all clinical work of the patients on the service.
• As a teaching assistant in the OR, the chief resident can guide junior residents in basic surgical operation e.g., appendectomy. This teaching assistance role counts to the chief resident overall operative log and helps him /her develop teaching skills. This teaching assistance role is under faculty supervision who is immediately available as needed by the chief resident.
• Chief residents continue to communicate with supervising faculty on all cases.
• The fifth-year is truly a finishing year, improving skills and preparing residents to practice independently without supervision. Each chief resident also assumes an administrative role in the residency, organizing departmental conferences, managing Grand Rounds, or planning ABSITE prep sessions.

PGY-5 Rotation

The Surgical Service at Riverside Community Hospital is divided into the following teaching services:

• 2 blocks (General, Thoracic, Vascular, Surgical Oncology)
• 4 blocks (General, Minimally Invasive Surgery and Bariatric surgery)
• 4 blocks (Vascular, Thoracic Surgery, and Surgical Oncology)
• 2 blocks (Pediatric Surgery – Loma Linda University Medical Center)
• 2 blocks (Transplant)