Residency  >  Specialties  >  General Surgery

Jefferson's department of surgery cares for general surgery patients on four services, in which the resident spends about 65 percent of his or her five-year program. The Green Service encompasses general, oncologic and endocrine surgery. The Blue Service consists of general, pediatric, plastic and oncologic surgery. The White Service is primarily a vascular service. And the Red Service is a colorectal service. Each of these services has an average load of 30 to 50 patients. Residents make all surgical-care decisions and perform all operative interventions under the direction of the chief resident, with overall supervision by the attending surgeon. Surgical residents act as the operating surgeon in 95 percent of the general surgery cases at Jefferson, with the attending physician serving as first assistant.

The chief resident runs the busy University surgery service with the help of junior residents. This allows the chief resident to function as an attending who may consult, as needed, with a member of the general surgical staff. Residents and interns, under the direction of the chief resident, preoperatively assess and operatively manage the myriad patient needs. The staff holds office hours to complement in-hospital care.

Daily operating room and bedside teaching remain the mainstays of the educational program at all levels. The faculty encourages inquiry and dialogue among all levels of residents in order to foster a scholarly environment. A mandatory weekly morbidity and mortality conference, moderated by the chairman, reviews patient management problems encountered during the previous week. Each week at this meeting, formal case presentations are made followed by a dissection of the decisions and techniques to highlight important teaching points.

The formal, academic program of the department is given over a two-year cycle. One year is too brief a time to adequately cover all aspects of surgery. A two-year cycle offers a more relaxed pace and permits residents to review topics more than once during their residency, thereby permitting greater insight each time a topic is covered. Thursday mornings provide protected educational time for all surgical residents. Weekly Grand Rounds is a case-based didactic in-depth presentation by a faculty member or visiting professor. After Grand Rounds, formal lectures given by faculty and senior residents, basic science reviews, and patient management discussions (mock oral exams) make up the bulk of these teaching sessions. In addition, monthly Journal Club meetings afford residents an opportunity to review current surgical literature and interact with attendings in an informal setting.

There are numerous specialty conferences, held weekly, biweekly, or monthly, which surgical residents and faculty are welcome to attend. These include multidisciplinary GI, transplant, pulmonary, cardiac, trauma, colorectal, vascular, oncologic, breast and endocrine conferences. Surgical residents are frequently asked to suggest topics and present interesting cases at these conferences.

Oncology
Jefferson’s surgical staff performs approximately 14,000 operations per year for oncologic diseases. Jefferson’s Bodine Center for Cancer Treatment, as well as the hospitals in the Jefferson Cancer Network, refers many cancer patients to us. The operating suite, located in the heart of the center, allows surgeons to team with radiation oncologists to administer intraoperative radiotherapy and to place radioactive seeds for malignancies that are difficult to treat surgically. Jefferson has pioneered both of these techniques. Annually, Jefferson surgeons perform a large volume of lung, endo-crine, intestinal, colorectal and breast surgeries for cancer. Jefferson residents obtain a broad experience in treating malignant diseases and learn multidisciplinary approaches to providing patients with optimal therapies.

Endocrinology
Residents at Jefferson can expect exposure to a broad range of patients requiring endocrinological surgery. Residents apply their skill regularly to abnormalities of the thyroid, parathyroid, pancreas, adrenals and other glands. At the end of training, residents are proficient in the techniques of thyroidectomy, parathyroidectomy, adrenalectomy and pancreatectomy. Complementing the clinical experience are monthly conferences in the division of endocrinology and metabolism, as well as regular meetings of the Philadelphia Thyroid Society.

Plastic and Reconstructive Surgery
Jefferson’s respected plastic-reconstructive surgery service addresses a long list of needs, including reconstruction for congenital anomalies, trauma and cancer ablation. The service employs tissue transfer and microsurgery, among other techniques. Because Jefferson has no plastic-surgery fellows, residents on this rotation act as primary surgeon or first assistant in all operative procedures and are directly responsible for management of the service’s patients. Residents become familiar with implant surgery as well as fine-tissue microvascular techniques. The Jefferson faculty has a successful record of helping to place residents in the top plastic- and reconstructive-surgery fellowship programs nationwide.

Burns
During the second year of training, residents complete a rotation at the Crozer-Chester Burn Center. A referral area with a 200-mile radius provides the center with more than 250 patients annually. With a 17-bed capacity and an eight-bed, critical-care unit, Crozer-Chester offers residents an excellent opportunity to gain familiarity with the principles of burn-wound management, fluid and electrolyte replacement, ventilator therapy and surgical nutrition. The center’s full-time staff of three acute-burn surgeons and three plastic surgeons provides highly specialized training in both acute and long-term burn management. Approximately one quarter of admitted patients have concurrent smoke inhalation injuries and about one quarter are children.