Surgical Residency at University of Virginia

Hi there,
I am three and one/half months from finishing my PGY-1 year here at the University of Virginia in General Surgery. I thought I would put some information out here on how residency in Surgery works here at UVA and why I love this program so much.
First of all, you go though medical school and you graduate. Somewhere along the way, you participate in the Match and get into Surgical residency. What have you signed on for? Some folks (like me) think you have signed on for the ultimate ride but others find themselves in more “he–” than they could ever have imagined. Those are the folks that sought surgery for reasons other than sheer love of this profession. It is by far, the most unforgiving residency and specialty.
Here at UVA, we have the usual three categories of PGY-1 folks in Surgery. There are the categorical folks who are going to finish residency in General Surgery. There are the designated preliminary folks who are going to finish residency in other surgical disciplines such as Anesthesia,Orthopedic surgery, ENT, Neurosurgery, Plastic Surgery and Urology. Some Anesthesia residents elect to do a PGY-1 year of surgery rather than medicine because they want the heavy emphasis on becoming comfortable with procedures. Doing a year of Surgery is more time-consuming than medicine but many folks elect to do this. The last category of PGY-1 are the non-designated preliminary residents who are going to other programs such as anesthesia or even to other surgery programs. They elect to do a year in a heavily academic center such as UVA and enter other programs with that base. They may do one or two years but they are not obligated to finish residency at UVA though some do wind up finishing here.
The first year of residency consists of 12 rotations of one month each with the first rotation actually being six weeks long instead of four. We change rotations on the first day of each month. You individual schedule will vary but your rotation will consist of rotations though, Colo-rectal surgery, laparoscopic surgery, cardiac surgery, thoracic surgery, pediatric surgery, vascular surgery, general surgery at the VA Hospital, surgical oncology, trauma surgery, surgical intensive care and plastic surgery. My schedule this year has given me two rotations on Vascular Surgery, Surgical Intensive Care,Trauma Surgery Intensive Care, Pediatric Surgery, Colo-rectal Surgery, Endocrine Surgery,Transplant Surgery, Hepatobiliary Surgery, Laparoscopic Surgery, Thoracic Surgery, Surgical Oncology and two months of General Surgery at the VA Hospital. I finish with being the night float General Surgery Intern. I did one week of Plastic Surgery instead of a month and covered Cardiac Surgery as the night on-call person. My laparoscopic surgery experience was my total favorite but vascular has been a surprising second. My intensive care work both SICU and Trauma ICU were the most stressful but looking back now, the rotations where my learning curve was the highest. (If you had told me last year this time, that one year later, I would be totally comfortable managing a fresh post-op liver transplant, I would have said you were crazy but I am totally comfortable with some of the sickest patients in the hospital). You learn so fast in surgery because of the nature of the work.
The second year of residency is spent in two month rotations with opportunities to become the covering chief resident for some weekend call. You rotate on Thoracic, Cardiac and Vacular ICU, Surgical Nutrition and Endoscopy, Vascular Surgery, Laparoscopic Surgery, Surgical Oncology, Trauma ICU and General Surgery at the VA Hospital. You are expected to learn how to completely do cases and play a major role in the performance of the cases. Your attending physician will be assisting you on the performance of many of your operative cases. You have more responsibility and you will get a heavier case-load in the OR. Since you are the primary operating junior-level resident, you are responsible for knowing the case from the skin to skin. As a PGY-1, you are never faulted if you miss a move, as a PGY-2, you are expected to know the junior level cases blindfolded. The best way to learn a case is to do the case over and over in your mind while you outline the case on paper or the blackboard. As a PGY-2, you are expected to be able to handle all sorts of Lines and vascular access. This is where my experience in SICU will be the most valuable.
As a PGY-3, most residents at UVA will enter the laboratory for two years of research. Most folks start to write chapters during this time. A few women have opted to give birth during these two years. By this time, you have learned the area that interestes you most. For me, I would love to do a project in Surgical Oncology working with some of the vaccine research for melanoma. I am also interested in shock states and low blood flow states which has roots in vascular surgery. The PGY-3 and PGY-4 years can be the most interesting years even though you are away from operative surgery.
The clinical PGY-3 year will find you chief of Transplant Surgery, Surgical Oncology and one of the senior-level residents on Colo-rectal Surgery, Endocrine Surgery, Thoracic, Laparoscopic Surgery or Trauma Surgery. The clinical PTY-3s are also the night consulting residents for the General Surgery service. As a clinical PGY-3, you are the person in charge (resource) of the general surgery night float intern and the trauma-admit intern. You are also the second in charge of the night traumas and will be the surgeon-in-charge of traumas if the night chief resident is scrubbed in a major case. Your main job as a clinical PGY-3 is to do many fairly major cases.
The clinical PGY-4 will be the chief resident on Trauma Service, Pediatric Surgery, Vascular Surgery and Private General at Rockingham Memorial Hospital. Each clinical PGY-4 spends three months on each rotation. You are a senior resident and manage these services entirely. Most of the clinical PGY-4 will be interviewing for fellowship during this point of residency unless they have elected to do General Surgery. Fellowships after a General Surgery residency include, Cardiothoracic Surgery, Trauma/Critical Care, Vascular Surgery, Laparoscopic Surgery, Hepatobiliary Surgery and Pediatric Surgery. At the end of your clinical PGY-4 year, you will know exactly where you will be going for fellowship or if you will be stopping at the end of residency and heading into private practice.
The clinical PGY-5 is the chief year. You will totally manage one of the four big services at UVA. These are Hepatobiliary Surgery, Colo-rectal Surgery, Laparoscopic Surgery and General Surgery service at the VA Hospital. You are also in charge of doing the administrative work of the entire residency program such as scheduling and the conferences. As a chief resident you are expected to participate at national level meetings and present papers and research. You are also totally responsible for the running of your service including managment of the case-load for your service. The chief residents manage the division of cases among the more junior residents. A clinical PGY-5 is as experienced as many of the junior attending physicians and can totally handle any problem in General Surgery. This year, all of our clinical PGY-5s are going into fellowships. Two will be staying at UVA for cardiothoracic surgery fellowship, one will be leaving for a Transplant fellowship and the other will be doing a Trauma/Critical Care fellowship. All of my chiefs have been excellent teachers and even better mentors. All of the chief residents at this point, have far more cases than they need to finish the residency. We still have three and one half months to go before the end of the year!!
General Surgery at the University of Virginia takes a total of seven years with two years spent in the research laboratory. The attending physicians and residents put out lots of papers and research in a variety of subjects most notably critical care/trauma, surgical infectious diseases a

nd laparoscopic surgery. The residency program in Surgery at UVA is very heavily focused on academics and study though none of the attending physicians are punative. You are expected to maintain your personal knowledge base. I have studied far more this year than the four years of medical school combined. In surgery, you have to learn the patient care medicine, the critical care medicine and the surgical techniques together. This residency is focused and integrated so that the academics and surgical techniques compliment each other. Our attending physicians are very well trained and from a variety of good academic programs such as UVA, Pittsburg, Penn, University of Minnesota, Lahey Clinic and Duke. The attending physicians all teach. There are no malignant personalities in this residency program among the attendings and any malignant entering residents are soon booted out. My residency director does not tolerate anything less than excellence. UVA offers fellowships in Vascular Surgery(1), Cardiothoracic Surgery(4) and Laparoscopic Surgery(1).
UVA Medical Center is very modern and totally computerized. We use very little paper and enter all orders by computer. This cuts down on handwriting errors and makes radiological studies available to use instantly. The drawback is that there is a learning curve to being able to work the computer system. It took me about three days to become comfortable entering orders and tracking down studies. Some folks are still struggling but I was fairly computer-literate before I came to UVA having used computerized systems at Howard, Mayo Clinic and Washington Hospital Center.
Males far outnumber females and out of a residency corps of nearly 45, there are three minorities. None of the fellows are female or minority. The University of Virginia is not a diverse program and looking at the likely incoming residents, will less diverse next year. Charlottesville is a small college town with a fairly uneducated population. The University provides the culture but the local gentry had an average educational level of fifth-grade. The population is by far, African American and Caucasian. There are few Asians in the community with a growing but not as of yet numerous Latio population that works mainly in the poultry factories of Rockingham County.
Most of our residents are married. Charlottesville is a very family-oriented community. There are great places to live and housing is fairly cheap compared to urban areas. We have an airport that serves many of the major hubs on the east coast and is served by United, American and US Airways in addition to commuter aircraft. Washington, DC and Baltimore, MD are 100 miles and 150 miles to the northeast respectively and easily accessable by bus, auto and train. Richmond, VA is 64-miles to the west and easily accessable by bus and auto. Richmond is the state capital of Virginia and a fairly large urban area. There is skiing, hiking and fishing within a 30-mile radius of Charlottesville.
I love this place but I work hard here. I am constantly amazed at how much I have grown in the few short months since medical school ended. Surgical residency is extreme and this place is an extreme residency but I seem to love the challenge. I spring out of bed each morning and I groan when I get four calls in the middle of the night about the same thing that I addressed six hours earlier but all in all, I having the time of my life here at UVA and I am looking forward to the challenges of next year here.

biggrin.gif Hi Nat!
Thank you so much for sharing with us. You have given such an insight that I could never imagine. Although I know that each person's experience is different, your experiences have allowed me to see what's in store.
Again, thank you...........

so during the 2 yrs of research - what kind, if any, clinical exposure are you getting? do the clinical PGY-3 residents have any trouble readjusting to the clinical world after nearly 2 years in research?

QUOTE (LisaS @ Mar 14 2003, 06:01 PM)
so during the 2 yrs of research - what kind, if any, clinical exposure are you getting? do the clinical PGY-3 residents have any trouble readjusting to the clinical world after nearly 2 years in research?

Hi there,
The research PGY3 and research PGY-4s do not get much clinical exposure during the lab years. Formerly, they would be tapped into service during the Christmas/New Year's holiday season but the 80-hour work week swatted that arrangement so they will be doing research and little else.
Most folks adjust to leaving the research time pretty well; some better than others but like riding a bicycle, your skills come back pretty quickly according to the clinical PGY-3s. There is one clinical PGY-3 that did not do the reseach years. He is an MD-Ph.D who took a position vacated by a resident who decided that the UVA Surgery program was not for them. He came from Emory. There is no doubt that his skills were sharper than the folks who came out of the lab.
All in all, the clinical PGY-3s are a great bunch of folks who have been a blast to work with. They have been my greatest resource folks when it comes to seeing the surgical consults in the Emergency Department. When I am doing my 24-hour call, they are good about buzzing me to put in chest tubes and do procedures like sigmoidoscopies. I need the practice and they don't mind teaching me.
Another great aspect of this residency program is that we all look out for each other. rolleyes.gif

compared to getting into med school, I have found very little about the residency process. Is it as unnerving as the med school route?

QUOTE (Kahkeetsee @ Apr 10 2003, 10:43 AM)
compared to getting into med school, I have found very little about the residency process. Is it as unnerving as the med school route?

Hi Kathy,
The residency thing is thousands of times easier than getting into medical school. It is more like interviewing for a job. You will get into a residency somewhere if you graduate from medical school so it is not like getting into medical school in the first place. That being said, you can be the master of your fate if you do well in medical school. You do not have to ace every class but having and exercising a good work ethic will get you further than almost anything else. Once you get out of medical school, your work ethic will keep you going forward in medicine.
You also have to stop getting into the "head games" about which residency is competitive and which program is the top program for this or that. The best residency program is one that you have a good fit. You have to get up every morning (early) and work with your colleagues for many hours. It doesn't matter if your program is the so-called "top program" if you can't stand the people that you work with.
Some of my fellow interns are wonderful and some have been totally incompetent. It is fortunate that the incompetent folks will not being going on at UVa next year. My residency director does not keep idiots. I struggled every day and continue to struggle to be the best surgeon that I can. I still get "flightly" huh.gif when I am dropped into new situations but I am learning to think about the next step and get the job done.
When I am done with this 2-month stint at the Veteran's Hospital here at the end of May, I will be much better at doing solid work-ups for consults and in clinic. It's all about learning how to practice good medicine and give good care.
It's fun too!!! biggrin.gif

Hi Folks,
It’s residency interview time at the University of Virginia and the folks in black suits have been parading through the hallways with their little folders. For the Surgery Department, the lab residents are responsible for conducting the tours; the faculty are responsible for getting the interviews done. There were a total of 618 applicants for four general surgery categorical resident slots and one plastic surgery categorical slot. These 618 were narrowed down to 75 that were invited for interview. There are three interview days so 25 come each day. Sometime in February, the applicants invited for interview will submit their rank lists and the UVa Surgery will submit their rank lists. The big computer will match applicant with program and on Match Day, folks will find out if they matched at UVa or anywhere else. Until then, they walk around the halls in their little black suits looking very much like a "mortician’s convention."
Along with the fourth year medical students who are interviewing for residency positions, the clinical fourth-year (PGY-4) surgery residents are interviewing for fellowships. UVa takes two Minimally Invasive Fellows (who have junior attending status), two CardioThoracic Fellows (who have Senior Resident status) and one Vascular Fellow (who has Senior Resident status). These applicants for fellowships will go back to their programs as clinical PGY-5 Chiefs next year and will begin fellowship after completing their General Surgery residency.
UVa Surgery does not have a fellowship program in Pediatrics, Transplant Surgery, Surgical Critical Care/Trauma or Surgical Oncology (the other four fellowships that are open to people who have completed their General Surgery residency.
There is also a new wave in General Surgery where a clinical PGY-4 can opt to take a year doing Rural General Surgery or Surgical Critical Care, then return to finish their PGY-5 year and become eligible to sit for both Critical Care Boards and the General Surgery Boards after completing their residency program. If you add the two years of lab research required by UVa, you have some pretty long training after medical school before you are a practicing General Surgeon. The chiefs that are graduating at the end of this year have been seven years in residency total. Three out of the four have opted for completing a Cardiothoracic Surgery fellowship which will addd two more years to the seven that they have completed. If any of the Cardiothoracic fellows opt for an additional year in Pediatric Cardiothoracic Surgery or Congestive Heart Failure Surgery (both of these are one year superfellowships), they will have completed ten years of training above medical school before getting to the attending level.