When you graduate from our program, you will be a confident general surgeon ready for practice or further education in a subspecialty fellowship. In addition to our five-year curriculum, your education will be augmented with patient care, formal rounds, conferences, basic science lectures, journal clubs, bioskills sessions, and research with WMed faculty. Residents are also offered the option to pursue one to two years of research following their PGY-3 year. Together, we make the teaching of other residents and medical students an integral part of your academic experience. All residents complete the requirements for certification by the American Board of Surgery. Our graduates have been extraordinarily successful in obtaining premier fellowship positions.
Night Float System: The newly implemented Night Float System ensures that residents have appropriate coverage without risking duty-hour violations. Additionally, this system gives our junior residents the opportunity to enhance their surgical skills during weekdays in the regular rotations and to provide them with very close supervision during the night calls by both faculty and senior residents. This new night float system was proposed by our current chief residents and adopted by the program with great success.
Rotations
The vast majority of training takes place at WMed, Bronson Methodist Hospital (BMH), and Ascension Borgess Hospital (ABH) in Kalamazoo, with the focus on the primary components of general surgery. Elective rotations are available to all residents and include away rotations in surgical subspecialties or global surgery. Residents in the Rural Surgery Program have the opportunity to do rotations at Ascension Borgess Allegan Hospital, Bronson LakeView Hospital, and Bronson Battle Creek Hospital.
- PGY-1 Schedule
Rotation Blocks Location General Surgery 6-7 WMed/ABH/BMH Borgess Acute Care/Trauma 2-3 ABH Bronson Night Shift 2 BMH Pediatric Surgery 1 BMH Bronson Trauma Surgery 1 BMH - PGY-2 Schedule
Rotation Blocks Location General Surgery 5-6 WMed/ABH/BMH Borgess Acute Care/Trauma 3 ABH Endoscopy/Colorectal Surgery 1 WMed/ABH/BMH Borgess Night Shift 2-3 ABH Bronson Trauma Surgery 1 BMH - PGY-3 Schedule
Rotation Blocks Location General Surgery 5-6 WMed/ABH/BMH Borgess Acute Care/Trauma 2-3 ABH Pediatric Surgery 1 BMH Borgess Night Shift* 0-1 ABH Cardiothoracic Surgery 2 ABH Elective 1 Varies** *A PGY-3 covering ABH Night Shift will have one less block of ABH ACS.
**Electives include away rotations in surgical subspecialties or global surgery. - PGY-4 Schedule
Rotation Blocks Location General Surgery 5-7 WMed/ABH/BMH Bronson Night Shift 0-1 BMH Borgess Breast Surgery 1 ABH Transplant Surgery 1 Henry Ford, Detroit Bronson Trauma Surgery 3-4 BMH Elective 1 Varies** **Electives include away rotations in surgical subspecialties or global surgery.
- PGY-5 Schedule
Rotation Blocks Location General Surgery 10-11 WMed/ABH/BMH Bronson Night Shift 1-2 BMH Elective 1 Varies** **Electives include away rotations in surgical subspecialties or global surgery.
Operative Experience
In the WMed General Surgery residency program, we place a deep emphasis on providing excellent hands-on training in the operating-room as well as in simulation labs. All of this serves our mission that each graduate of our program is equipped with the skills and confidence to be a top-notch surgeon ready for practice or continuing education in a subspecialty fellowship. This unparalleled clinical and operative experience begins early as an intern with progressive advancement in case volume, and complexity, during residency. The following tables shows the average Operative Experience in Defined Categories and by PGY.
- Operative Experience in Defined Categories
Group Defined Category RRC Minimum WMed Average Ratio of Program Average to RRC Minimum Skin and Soft Skin and Soft Tissue 25 94 3.8 Breast Mastectomy 5 30 6.1 Axilla 5 12 2.4 Breast Total 40 49 1.2 Head and Neck Head and Neck 25 52 2.1 Alimentary Tract Esophagus 5 10 2.1 Stomach 15 46 3.1 Small Intestine 25 55 2.2 Large Intestine 40 82 2.1 Appendix 40 118 3.0 Anorectal 20 31 1.6 Alimentary Tract Total 180 343 1.9 Abdominal Biliary 85 223 2.6 Hernia 85 174 2.0 Liver 5 11 2.2 Pancreas 5 8 1.7 Abdominal Total 250 463 1.9 Vascular Access 10 30 3.0 Anastomosis, Repair, Exposure 10 34 3.4 Vascular Total 50 146 2.9 Endocrine Thyroid or Parathyroid 10 27 2.7 Endocrine Total 15 29 1.9 Operative Trauma Operative 10 21 2.1 Non-Operative Team Leader Resuscitation 10 16 1.6 Non-Operative Trauma Total 40 50 1.3 Thoracic Open Thoracotomy 5 9 1.9 Thoracic Total 20 25 1.2 Pediatric Pediatric 20 41 2.1 Plastic Plastic 10 23 2.3 Surgical Critical Surgical Critical Care 40 61 1.5 Laparoscopic Laparoscopic-Basic 100 340 3. Endoscopy Upper Endoscopy 35 5 57 Colonoscopy 50 70 93 Endoscopy Total 85 192 2.3 Laparoscopic Laparoscopic-Complex 75 120 1.6 Role Totals Total Major Cases 850 1,232 1.4 Total-Surgeon Chief 200 346 1.7 Total-Teaching Assistant 25 36 1.4 - Operative Experience by PGY
Cases by PGY Average PGY-1 Total 355 Average PGY-2 Total 226 Average PGY-3 Total 286 Average PGY-4 Total 321 Total Chief Cases 355 Total Major Cases 1,335 *Numbers represent a four-year (2018-2021) average based on graduate case logs.
Feedback and Evaluation
Our residents are provided with extensive and frequent feedback, through informal and formal means. Among other things, our program administers end-of-rotation evaluations, intraoperative evaluations assessing operative autonomy, and a comprehensive semiannual evaluation from the Clinical Competency Committee (CCC) based on the ACGME Milestones. All these serve to provide residents with formative feedback to help them track their progress and development.
Global Surgery Pathway
WMed General Surgery has developed a Global Surgery Rotation for residents interested in educational experiences in developing countries. This rotation aims to enable interested and qualified surgery residents to undertake clinical, educational, and research opportunities in places with limited resources.
Didactics
- Weekly
At WMed, Thursday mornings, 7:30 a.m. to 12:30 p.m., (i.e., 5-hour morning block) are protected time for our General Surgery residents to attend didactic and skills lab sessions with residents excused from clinical duties in order to participate. Residents participate in setting the schedule and choosing topics based on educational goals, with faculty proctoring and moderating. Most activities take place at WMed’s Oakland and/or Upjohn campuses, with occasional travel to an outside research lab for bioskills (animal labs).
A typical conference schedule would include:
- Morbidity and Mortality Conference (M&M)
Attended by all residents and faculty. Currently we use a hybrid platform (in-person and virtual for those who are unable to attend personally).
- Core curriculum based on SCORE Curriculum
These are prepared and led by a senior resident and a faculty member for small-group, interactive discussions. Incorporated into this is “This Week in SCORE (TWIS)” as an interactive session to better fit with the program schedule.
- Program ABSITE review
Two or more hours per week is dedicated specifically to ABSITE review in the months of December and January (i.e., prior to the exam).
- PGY1-2 ABSITE review
Approximately 15 sessions distributed over 4 months (weekly or biweekly).
- Attending rounds
Attending physicians round with our residents, students, and staff every week at both hospitals.
- Rotation-specific conferences
Service-specific Morbidity and Mortality conferences (e.g., Trauma and thoracic surgery). The services at Bronson Methodist Hospital and Ascension Borgess Hospital each conduct their own weekly/monthly teaching conferences as well.
- Morbidity and Mortality Conference (M&M)
- Monthly/Quarterly
- Grand Rounds
Held approximately once per month. Attended by all residents and faculty. The department has funding for two visiting professors per academic year.
- Surgery Department Monthly Research Meeting
Residents and faculty with active research projects attend this meeting to discuss their progress.
- Resident Business Meeting
Held monthly with both junior and senior residents to discuss issues related to the working environment and any matters to be addressed.
- Surgical Journal Club
Held every other month, with residents selecting the topics in general surgery and surgical specialties.
- Quality Improvement/Patient Safety, RCA Curriculum
Held quarterly with a focus on quality improvement projects that draw on Lean principles and methodology.
- Surgical Ethics Lectures
Occurring twice a year with case-based discussion sessions led by the faculty in the Department of Medical Ethics, Humanities, and Law.
- GI Tumor Board
Held biweekly and monthly in collaboration with WMCC, this event utilizes a multidisciplinary approach to discuss cases.
- Grand Rounds
- Annually/Semiannually
- WMed Research Day
Held over two-half days in the spring of each year. Surgery residents are expected to attend research event and present their research projects.
- Annual Surgery Research Day and Cancer Symposium
Held historically in the month of September, in collaboration with WMCC, all surgery residents, except new interns, are required to submit an abstract/research project for presentation. PGY1s are encouraged to submit research ideas/questions for discussion. Vising professors with expertise in specific topics are invited to give talks based on the theme of the conference.
- October Comprehensive ABSITE examination
A SCORE-based MCQ 4-hours. An ABSITE-simulated test based on SCORE outlines. It aims to identify gaps in medical/surgical knowledge of residents 3 months before the actual ABSITE (in January) and help them create a study plan to address any deficiencies. We published the benefit of this approach few years ago.
- A formal mock oral examination takes place twice a year (in September-October and March-April) to prepare for the American Board of Surgery Certifying examination with specific formative and summative feedback using the ABS evaluation form. Chief residents also receive specific evaluations on their operative performance in key areas.
- WMed Research Day
Simulation Program
A robust simulation is an integral component of our curriculum, and all residents of all levels are required to participate in surgical skills training. The simulation program is structured to ensure residents start building their skills as soon as they start in training. Early skills acquisition helps residents achieve proficiency. This is an important element toward granting early autonomy in the operating room. We use a well-defined curriculum (weekly, monthly, and annually), and we utilize the ACS/APDS Surgery Resident Skills Curriculum.
- Weekly
- Surgical Skills Development Program is a newly implemented 1-hour program that is aimed to be an integral component of the resident experience at WMed. The sessions provide junior (especially new interns) and seniors residents with opportunities to enhance their skills outside of the operating room.
- Robotic Surgery
Surgery residents are exposed to robotic surgery at ABH and BMH. A national curriculum is being developed for all surgery residencies. Intuitive Surgical provides extensive online training for surgeons and residents and ensures a thorough understanding of robotic technology and its clinical applications. Our residents are required to complete online modules as an initial step in a well-designed program.
- Monthly
- Bioskills lab
- Animal labs are conducted 4-6 times a year at Charles River Laboratories, Mattawan, MI.
- Cadaver lab are conducted 3-4 times a year in the WMed
- Dry labs are conducted 3-4 times in the state-of-the art Simulation Center at WMed.
- Bioskills lab
- Annually
- Advanced Surgical Skills for Exposure in Trauma (ASSET™)
- Senior residents participate in this one-day cadaver-based course providing an overview of surgical exposures in key areas (e.g., neck, chest, abdomen, pelvis, and upper and lower extremities. Residents receive hands-on exposure with the guidance of faculty.
- Dedicated New Intern Bootcamp, vascular lab, and ultrasound skills take place early in the academic year
- Residents at PGY 1-2 are required to pass FLS and FES early in their junior years.
Research
As an important element of residents’ professional development, all residents participate in research projects and scholarly activity. Partly as a mandatory requirement of the ACGME, and partly driven by resident interest, our residents are mentored beginning as a junior with increasing participation as they progress through their training. WMed provides funding for residents who present their work in regional/national/international meetings. While dedicated time for research is not required, the program supports residents who elect to take time away (1-2 years) from clinical training for research after PGY3.
Resident Wellness
- Resident Wellness
Held every 3 months. Residents are given the opportunity to enjoy 4-5 hours off on four Thursday mornings each year to attend to personal tasks that can be difficult to manage outside regular business hours (i.e., doctors’ appointments, haircuts, etc.) to help promote work-life balance. - Resident Retreat
The department funds and organizes an annual resident-only retreat with a recreational activity that aims to bolster both team building and stress relief. - Resident Picnic
The department also sponsors a “welcome” picnic for the residency program early in the academic year. Residents, faculty, and staff (and their families) are invited for an afternoon of summer fun, historically held at one of our faculty’s homes.
Affiliated Hospitals
In addition to WMed outpatient surgery clinics, our WMed faculty and community faculty teach and train our residents at Bronson Methodist Hospital and Ascension Borgess Hospital.
- Bronson Methodist Hospital is the flagship of Bronson Healthcare Group, a not-for-profit healthcare system serving southwest Michigan and Northern Indiana. With 404 licensed beds and all private rooms, Bronson Methodist Hospital provides care in many specialties – surgery, orthopedics, cardiology, emergency medicine, neurology, oncology – with advanced capabilities in critical care as a Level I Trauma Center.
- Bronson Battle Creek (https://www.bronsonhealth.com/services/surgery/)
- Ascension Borgess Hospital is a 422-bed healthcare facility located in Kalamazoo, Michigan, offering a wide array of services and specialties. It has a Level II Trauma Center and offers strong exposure in vascular surgery, bariatric surgery, acute care surgery, and colorectal surgery.
- Ascension Borgess Allegan Hospital (https://healthcare.ascension.org/locations/michigan/mikal/allegan-ascension-borgess-allegan-hospital-general-surgery)
- Advanced Vascular Surgery (https://www.avsurgery.com)
- West Michigan Cancer Center (https://www.wmcc.org)
West Michigan Cancer Center (WMCC) offers a multitude of services including radiation oncology, gynecologic oncology, surgical oncology, and a clinical research department. A primary mission of the surgical oncology department is to educate all surgeons that complete general surgery training with an in-depth knowledge of the multidisciplinary treatment of solid malignancies (e.g., soft tissue neoplasm such as sarcomas, hepatobiliary neoplasm, and pancreatic cancers, foregut malignancy, endocrine surgical oncology, and cutaneous malignancy).