PGY1 Philosophy

The first year of residency is the beginning of a process that should produce a thoughtful, knowledgeable and competent surgeon. The first-year resident is at the beginning of five years of education that will call upon the doctor to once again become a student . These residents are introduced to surgical thinking, traditions, and limitations. We instill in them the notion that they must believe that they are the patient. We want the resident to become a keen observer and expert at history taking and physical examination. We will tell them to pretend that they may only see a particular disease presentation or operation once. That concept forces the doctor to focus sharply on the moment. Throughout residency, the mantra, "Do what's right," is stressed.


The first year resident begins to understand the art and science of coordinating judgement and a sick patient. They place the patient along the natural course of disease and evaluate different treatment algorithms. The emphasis is on learning the fundamentals of patient care: fluid and electrolyte balance, nutritional care, wound care and healing, aseptic technique, universal precautions, treatment of infection and shock, and the principles of transfusion and hemostasis. The rotations during the first year in general surgery - ICU/ER - are designed to reinforce these fundamental principles. In the ER, he/she will be the first to evaluate patients with acute problems and be supervised by more senior residents and the attendings.

The major assessment of whether the patient is better, worse or the same is stressed. They learn which situations are emergency, urgent or elective. The judgment of proper timing is emphasized. Safe surgery is the object of all surgery. PGY1 residents do daily rounds and learn to work effectively with nurses. They quickly find that many nurses are clinically very experienced and very helpful. The residents also learn to interact with the Pathology and Radiology departments. These relationships are essential for good surgical patient management.


The residents often assist in the OR and ER. They will perform basic operative maneuvers under supervision. He/She will write post-operative orders. There are suture practice sessions and laparoscopic training equipment. They gain insight as to exactly why certain surgery is technically hard and why five years of training is necessary. Attention to detail is constantly stressed. We feel that a large dose of compulsiveness is a virtue in a surgeon.


We hope to instill good learning and reading habits. Residents learn the difference between anecdotal experience and scientific proof. Demagoguery never wins when compared with double-blind randomized studies. Basic science is reviewed weekly, structured by chapters from the "Physiologic Basis of Surgery" by J. Patrick O'Leary and the Surgical Resident Curriculum. Every Categorical resident is expected to write at least one paper per year. These papers are part of the Housestaff Research Paper Competition. The resident learns how to plan a project and hopefully experience the joy of one question leading to another. The PGY1 residents are involved with medical student teaching. Teaching students is an obligation and a privilege.