Surgery Residency Program Brochure

The program application is available here.

Cabrini Medical Center is a 519 - bed acute care hospital which serves middle and lower Manhattan and other boroughs of New York City, and its surrounding suburbs.

The number of surgical procedures performed on a daily basis exceeds the minimal number recommended by the Residency Review Committee in Surgery and the American Board of Surgery. In addition to the large volume of in-patient operations per formed, there is an excellent facility created especially for ambulatory surgery patients. The requirements outlined in the Essentials of Accredited Residencies mandating that General Surgery Residents gain exposure to the surgical sub-specialties is made easy at Cabrini Medical Center. Since Gynecology, Otolaryngology, Plastic and Reconstructive surgery, Neurosurgery, Thoracic/Vascular surgery and Urology are all under the direction of the Program Director in General Surgery, the residents gain primary exposure to these disciplines and perform operations in these subspecialties throughout their five-year training period. It is our belief that this is a far more meaningful educational experience than rotating through each of these disciplines in separate block-time segments. The Department of Surgery offers other state-of-the- art surgical services for the benefit of our residents, including microscopic and Laser surgery, as well as Laparoscopic surgery, both basic and advanced. The resident staff participates in and performs these procedures on a regular basis. In addition, it is important to note that the number of endoscopic procedures performed at Cabrini by the surgical residents is at a high enough level to ensure that all of our graduates are qualified to perform endoscopy of all types. Cabrini Medical Center maintains a very active Emergency Services facility and is a participant in the New York City 911 Emergency Services System. As such, it oversees the operation of a paramedic ambulance service. All residents experience Emergency Room exposure at some time during their training. This allows them to become proficient in the management of all types of surgical emergencies on a first encounter basis. There is, of course, an active Outpatient Department. This facility provides a full range of primary medical care, including general surgery and all of the surgical specialties with which our residents must become familiar. Our house staff runs this clinic, with a member of the surgical faculty always in attendance. The management of these patients, including those who are admitted to the hospital is the responsibility of the Chief Resident in General Surgery and his team. As evidence of the commitment to teaching, the Director of Surgery, with the cooperation of a very interested and involved Administration, has appointed 11 attendings as Core Faculty Members. All of these attendings are salaried. All of the salaried Faculty Members are Board Certified surgeons. This includes the sub-specialists. Also, there is a large number of voluntary physicians who participate in the teaching of house staff and have traditionally been extremely generous in allowing house staff to participate in the clinical management and surgical treatment of their patients. It is our feeling that a distinct benefit of having a residency program in a community hospital, with its consequent smaller house staff, is the one-on-one involvement between Attendings and Residents. The entire Faculty of Cabrini is dedicated to this practice.

To assist him in assuring a smoothly running residency program, the Director of Surgery has appointed an experienced surgeon and teacher to the role of Associate Program Director, who works very closely with the Director of Surgery as a liaison between the residents and the entire teaching faculty. His duties include assisting the chief residents with scheduling at Cabrini and Mount Sinai, maintaining a detailed resident evaluation program and, along with the Director of Surgery, serving as a career counselor for the residents.

The structure of the surgical teaching program at Cabrini Medical Center is simple, but educationally sound. The Department is divided into two services - Referred and Non-referred. Historically, these divisions have been described in various ways across the Country, most commonly as Private vs. Service divisions or Private vs. Resident divisions, respectively. At the head of each division is a Chief Resident assisted by a PGY-4 Senior and a team of Junior house staff members. There are three sources from which the Non-referred (Resident) Service come: patients admitted through the Emergency Room via the EMS Ambulance who do not have a private physician, patients from the other medical specialties, particularly Internal Medicine, who have the same Non-referred status and whom the surgical residents are asked to see in consultation when such requests are made. The third source comes through admissions from the outpatient clinic. At the head of the Non-referred Service, the Chief Resident assumes the duties of an Attending, under the teaching supervision of the Faculty, as mandated by the RRC. Residents at all levels have primary responsibility for the development and implementation of patient treatment plans, from initial assessment, through surgery and into the postoperative period. All surgery on this service is performed by residents, under the supervision of the Surgical Faculty. When assigned to the Referred Service (Private), residents work closely with the surgeons on the voluntary staff, often in their private offices. Again, trainees experience the full spectrum of patient care before, during, and after surgery. Residents gain first-hand exposure to private practice surgery, thus learning the principles of operative treatment along with the intricacies of total patient management. Referred patients constitute a significant portion of the teaching caseload. As mentioned, the tradition at Cabrini has been that all Attendings recognize that every patient admitted is a "teaching patient" and that the residents must participate intimately in their clinical management and operative care. The philosophy of the Department is that of "one patient/one doctor". Once a trainee has been assigned to a patient, Referred or Non-referred, the patient becomes his/her responsibility. Should complications arise, the respective Resident handles the problem, along with the Attending of record. This teaching principle is not actually revolutionary; it is the way of life a surgeon must pursue when he/she enters the world of surgical practice. The sub-specialty rotation in Orthopedics takes place at the Cabrini Medical Center. Cardio-Thoracic and Transplantation Surgery are experienced through separate rotations at the Mount Sinai Hospital where the educational exposure is extensive, and a Burns rotation is offered at the New York burn center at New York Hospital Cornell Medical Center. Trauma rotations occur at the Elmhurst Hospital, another close affiliate of Mount Sinai. Elmhurst is a New York City Municipal Hospital and is a designated Level 1 Trauma Center. At some time during this rotation, the residents participate in the care of Pediatric surgical patients.

Educational Experience
The Cabrini/Mount Sinai program has been designed to provide our residents with outstanding opportunities to develop those qualities which a good surgeon must develop over his/her five years of training: clinical management of the sick patient, technical expertise which this management entails, and equally importantly, the sound surgical judgment that surgeons must possess. At the conclusion of the five-year residency program, our residents are well-equipped to enter any number of career pathways that will be described in another section of this brochure. All house staff officers participate in teaching residents who are their juniors and third-year medical students from the Mount Sinai School of Medicine. As expected, teaching duties increase with seniority. The residents, usually at the PGY-4 level, provide first encounter consultations for all patients on the other clinical services (Internal Medicine, Urology, Orthopedics, etc). The Cabrini Surgical Residency Program provides for two separate rotations in the Surgical Intensive Care Unit prior to reaching the PGY-4 level. The Surgical Intensive Care Unit has all the necessary up-to-date equipment for patient monitoring and computerized physiologic profiles which allow for minute-to-minute monitoring of their critically ill patients. Emphasis is continually placed upon education in the basic sciences, whether in the surgical ICU, at the bedside, or during formal didactic conferences, thus augmenting actual clinical experience. Stress is always placed upon the physiologic and metabolic management of the surgical patient. Outpatient Clinic exposure is a very important part of resident education. The program provides ample opportunities for pre- and postoperative management of surgical patients. As mentioned, the residents and the teaching staff attend the surgical clinic and house staff officers determine each particular patient's plan of care and are responsible for its implementation. Supervision is provided by the teaching attending, but the chief resident decides who is to be admitted and every patient is followed throughout the entire spectrum of his/her care by the same resident team. The general surgery clinic includes the following disciplines: Gastrointestinal, Vascular, Breast, Thoracic, Plastic, Hand, Surgical Oncology, and the other areas within the purview of general surgery. The surgical house staff officer at Cabrini Medical Center is accorded increasing operative and decision-making responsibilities in line with his/her ability and level of training. Typically, by the end of the first year, trainees are performing procedures in the operating room commensurate with their acquisition of skills. As technical skills advance, trainees are credentialed for more advanced procedures. In addition to significant operative experience, PGY-4 and PGY-5 residents assume greater administrative responsibilities, such as scheduling assignments for the junior house staff, planning conferences, inviting visiting professors to lecture, and more advanced teaching of medical students. Each Chief Resident conducts morning work-rounds on his/her respective service. Decisions concerning invasive and noninvasive monitoring, daily management, and preparations for operations are made at this time. There are evening "sign off" rounds both on the general surgical floors and in the Intensive Care Unit. In addition to training our residents to operate independently and to exercise sound surgical judgment, our curriculum has been designed to prepare trainees successfully for the American Board of Surgery Certifying Examination. The tentative 2003 - 2004 rotation schedule is as follows:

The number of residents at each level is as follows: PGY-1: 5; PGY-2: 3; PGY-3: 2; PGY-4: 2; PGY-5: 2. There are 2 categorical positions at each level as we graduate 2 residents from the PGY-5 level. The table below shows the resident roster as of December 2001.

Research Opportunities
Clinical research is an important component of the activities of the Cabrini Surgical Residency Program. Every resident is required to participate in a clinical investigative research project. More than 50 articles have been published over the past 15 years in various surgical journals in which the residents have been co-authors with the attendings. We have been exceedingly successful in meeting this important mandate of the RRC that each surgical residency program participate in scholarly activity to the fullest extent.

Conferences and Seminars
Weekly learning Conferences include: o morbidity and mortality, o grand rounds, o journal club, o tumor/oncology conference, o basic science - didactic, o surgical intensive care conference, o special clinical and basic science conference for junior house staff, o orthopedic conference/when on rotation. There are daily bedside teaching rounds with individual faculty members. Residents are required to attend all General Surgery and Basic Science Conferences. Attendance is required at sub-specialty conferences for trainees rotating through these services. This, of course, includes the rotations at Mount Sinai and Elmhurst Hospitals. Senior residents are sent to major conferences, including laparoscopy courses, regional surgical conferences held in many medical centers in New York City, and the regional conferences held by the American College of Surgeons. The Chief Residents are sent to the annual clinical congress of The American College of Surgeons at no cost to themselves.

Operative Experience
The RRC in Surgery maintains that a resident finishing 5 years in General Surgery should complete between 500 and 1000 procedures as surgeon. The experience in this program is that a resident generally performs between 800 and 900 operations at the conclusion of his/her 5 years of training. As mentioned, this exposure is broad and complete.
Career Pathways of Graduates

The Department of Surgery at Cabrini is proud of the successes our Residents have achieved over the years in being able to follow career pathways of their choice. At the conclusion of the Chief Resident year, surgeons trained in this Program have chosen to enter private practice immediately, or to pursue fellowship training in a surgical specialty. Of the 14 residents who graduated from our program between 1996 and 2001, five entered the practice of Surgery, and the other nine decided to further their training with fellowships or residencies, as the attached table summarizes.

Evaluation of House Staff
The performance of the Residents is monitored closely by the teaching staff at Cabrini and Mount Sinai Hospitals. Each trainee is evaluated individually on a quarterly basis by a faculty committee consisting of the full-time teaching attendings with substantial input from the voluntary staff. Evaluations are reviewed at subsequent individual meetings with each resident. Strengths and weaknesses are discussed and, if required, remedial study plans are developed. Additionally, all residents are required to take the annual American Board of Surgery In-Training Examination. The result of this exercise is not used, in and of itself, in evaluating a resident's performance. However, certainly by the 3rd year, performance on this examination becomes more important in the overall assessment of an individual resident's basic fund of information.

Housing and Quality of Life
Residents in the Cabrini/Mt. Sinai affiliated Program live in subsidized apartments provided by Cabrini Medical Center. The Department of Human Resources has been extremely cooperative and has even maintained a policy of assigning apartments based upon an individual resident's marital or family status. Cabrini Hospital owns two apartment buildings on the same street, and an appropriate number of apartments are reserved for all House Staff members. Since these apartments are immediately adjacent to the Hospital, residents may take call from their homes. The Hospital is located in a wonderful section of Manhattan, the gracious and historic Gramercy Park area. New York City remains, without doubt, one of the most exciting cities in the world. Whatever an individual's interest might be, these diversions can be accessed by anyone who so desires. This advantage is in keeping with another philosophy we maintain - the surgical resident is expected to work very hard, but there must always be time found to pursue leisure activities. New York City is certainly the place to pursue outside interests. There are internationally renowned cultural institutions in art, music, theater, opera and dance, as well as professional sports which are based in the city. Nowhere else can one find such an array of movies, museums, restaurants, stores, galleries, and a myriad of interesting things to do and see. The Gramercy Park area itself offers of many of these advantages within one or two blocks of the Hospital. As our enquiring students are told during the interview process, the most important aspect of these congenial meetings is to have the applicant learn as much as possible about every facet of life that a surgical residency at Cabrini Medical Center entails. We invite each prospective resident to return at any time after the interview to attend our conferences, or to again speak with the residents or the Program director, if they want additional information. We hope you will give us serious consideration and we wish you the best of luck.

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