Sinai Hospital General Surgery Residency Program

 

 

Thomas Genuit, M.D. Program Director

It is my pleasure, as the Program Director of the Sinai Hospital Program in General Surgery, to welcome your interest in our surgical training program and to provide a brief overview of the program, our vision and goals.

First and foremost, our goal is to train broad-based, highly qualified surgical specialists who can provide excellence in the care of patients with a wide range of surgical diseases. To this end, we have designed a training program that emphasizes education over service, training in all major surgical subspecialties, and strong academic affiliations. A well-chosen blend of hospitals, rotations and faculty exposes our residents to all facets of modern-day surgery to facilitate realistic and well-informed career choices in both academic and non-academic settings.

Knowledge is the most powerful tool we possess as surgeons. The Sinai Surgery Residency, with all of its members, strives to foster an environment of learning and research (basic and clinical), which enables our graduates to critically appraise surgical literature and keep abreast of surgical advances years after graduating from the program.

Surgeons today need to acquire knowledge and skills that reach beyond the classic teaching models of surgical education, and cover such variety of topics as leadership, business and systems management, health care finance and politics, and so forth. At the same time, the landscape of surgery is constantly changing. Core "general surgery" training in the future may be reduced to three to four years, and an increasing number of surgery graduates choose subspecialty training and careers. To train surgeons who will meet the demands and challenges of tomorrow, we have incorporated a unique value-added year of training into our residency design. During that year the resident may choose to complete a one-year executive MBA program, an MPH program, a year of research, or a Trauma/Critical Care fellowship, thereby leaving our program with substantial added qualification. Other qualified options for this year may be explored on an individual basis.

Below, you will find brief descriptions of the history of the program, our vision and mission, an outline of the value-added year, the educational exposure and basic design of the program, as well as an overview of the rotations and participating institutions in our program. Please feel free to browse the remainder of the residency Web site for additional information.

In closing, let me wish you the best of luck as you embark on your surgical career.

 

     Thomas Genuit, M.D., MBA, FACS
     Chief of Trauma Surgery
     Program Director General Surgery
     Sinai Hospital of Baltimore

 

Sinai Hospital of Baltimore, a member of the LifeBridge Health System, has a long tradition in surgical education, dating back to the early 1900s. Since that time, over 100 outstanding Sinai surgical residents have pursued careers in general surgery and various subspecialties at both academic and non-academic institutions throughout the country. The program has been closely academically affiliated with the Johns Hopkins University School of Medicine since 1957, when Dr. Alfred Blalock recruited Dr. Arnold Seligman, a well-known surgeon-scientist at Harvard, to be the first full-time academic chief of surgery at Sinai Hospital. In 1989, under the leadership of Dr. Gershon Efron (from the Albert Einstein College of Medicine) and Dr. John Cameron, the Sinai Surgery Program integrated with the renowned surgery program at the Johns Hopkins School of Medicine. This merger was pursued, following the belief that an integrated training program would strategically enhance the education of surgical residents across both hospitals. In its integrated capacity, the Department of Surgery at Sinai fundamentally contributed to the education of residents in general surgery and various subspecialties (plastic, cardiac, orthopedic and urologic surgery and neuro-surgery). From 1990 to 2005, nine to 12 residents, two to four medical students, and one to four students of allied health professions rotated at Sinai Hospital in the Department of Surgery at any given time, on two surgical and one SICU rotation. The residents were exposed to a broad spectrum of patient care, over 5,000 cases per year (inpatient and outpatient) in all major surgical specialties, and a broad array of educational activities. Emphasizing academic education, several residents participated in the research opportunities offered at Sinai Hospital, which resulted in numerous presentations, publications and prestigious fellowships in such surgical organizations as the Association for Academic Surgery (AAS) and Surgical Infection Society (SIS).

In 2005, due to the strict implementation of the 80-hour resident work-week and other major changes by the ACGME, ABS and other organizations, in the paradigms for surgical education, as well as structural changes at Sinai and the Johns Hopkins Hospital, the integration of the two surgical programs was resolved. Sinai Hospital successfully restarted its independent fully accredited program in 2006.  In 2009 the program was fully reaccredited without any significant citations, and in 2010 the ACGME approved a program expansion from 2 to 3 residents per year. 
Since Inception, we have successfully graduated four chief residents: Three of those residents went on to pursue the fellowships of their choice in Minimally Invasive Surgery [Case Western], Cardio-Thoracic Surgery [LIJ Northshore Health Systems] and Surgical Oncology [Roger Williams Cancer center]. One of our graduates entered practice with us at Sinai Hospital; he had previously completed a fellowship in Minimally Invasive Surgery and Endoscopy at Vanderbilt University. Two of our residents have successfully completed their in-residency Trauma/Critical Care fellowships [Johns Hopkins Hospital, and RA Cowley Shock Trauma Center] and two are currently enrolled in their research year at Massachusetts General Hospital [Vascular Research Lab, Dr. Cambria] and the Johns Hopkins Hospital [Breast Cancer Research Lab, Dr. Ramman].
Currently 14 residents (PGY I - V) are enrolled in the program, and the program will be completely filled with 18 clinical residents by 2014.

Program Vision:

It is the vision of the department chair, faculty, hospital and organization to create and maintain the most outstanding community-based, academically affiliated surgical residency program available to date.

This program will put high-level, broad-based education first and offer a flexible, innovative and value-added approach to training surgeons who will be prepared to meet the demands and challenges of tomorrow.

 

Educational Mission:

Central to the mission of Sinai Hospital and the Department of Surgery is the development of technically excellent surgeons with solid clinical judgment and a broad range of skills, engaged in the compassionate and effective care of all patients.

 

This residency program will:

• Provide a curriculum that will encompass extensive exposure to all surgical subspecialties through strategic specialty rotations at high-level, high-volume affiliated institutions and continued exposure at Sinai throughout the residency.
• Stress early and continued leadership responsibility to foster independent decision making.
• Provide residents with competencies in working and communicating in a multi-disciplinary team environment.
• Foster within residents the desire for the pursuit of continuous improvement, systematic evaluation of outcomes, and awareness of the underpinnings of the healthcare system and needs of the community served.
• Train individuals who are well equipped to pursue successful careers in general surgery.

 

To achieve the set goals, the residency will be structured into five clinical years plus one year of value-added post-graduate training. Throughout this time, the residents will:

• Receive clinical training in Bariatric & Minimally Invasive Surgery, Cardiac and Thoracic Surgery, Critical Care, General and Emergency Surgery, GI Surgery/Endoscopy, Gynecology and Gynecologic Oncology, Head and Neck Surgery, Neurosurgery, Orthopedic Surgery, Plastics, Soft Tissue and Burn Surgery, Pediatric Surgery, Surgical Oncology, Surgical Nutrition, Trauma Surgery, Transplant Surgery, Urology and Vascular Surgery.
• Be exposed to a large number (> 5,000/year) and variety of operative cases, in both the inpatient and ambulatory settings.
• Be exposed to peri-operative and outpatient management, emphasizing continuity of care, through participation in selected (multidisciplinary) clinics and outpatient care settings throughout the residency.
• Be trained and proficient in the six core competencies described by the Accreditation Council for Graduate Medical Education: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice.
• Be exposed to a comprehensive didactic educational program in the form of a core curriculum, subspecialty lectures, selective journal clubs, morbidity and mortality conferences, a surgical anatomy lab, a laparoscopic training lab, and an animal operative skills lab.  The educational curriculum will include clinical and basic science training and important practice topics related to the principles of coding and billing in surgery, risk management and ethical legal issues in surgery, professional liability, end-of-life care, delivery of bad news, and so forth.
  The Sinai Surgery Residency uses a curriculum with monthly topics, where lectures and assigned readings lead to monthly ABSITE preparation tests to consolidate the learned material and help the residents prepare for the annual Surgery inservice examination.  Sinai also uses the Multi-modality standardized national S.C.O.R.E. curriculum to enhance learning of the residents.
• Have access to state-of-the-art educational material through the hospital library services, ubiquitous computer and Internet access, and resident specific resource areas.
• Be offered training and certification in Basic Life Support (BLS), Advanced Cardiac (ACLS) and Trauma (ATLS) Life Support, Advanced Trauma Operative Management (ATOM), Focused Abdominal Sonography in Trauma (FAST), Fundamentals in Surgery (FS) and Laparoscopic Surgery (FLS) from the American College of Surgery, and other validated courses.
• Be exposed to the practice of surgery in the setting of a major (tertiary care) community-based hospital (Sinai), as well as in the setting of major academic facilities at our affiliated institutions.
• Be offered the opportunity to participate in basic, clinical and translational research throughout the course of the residency including presentation of such work at national meetings and in peer-reviewed journals.
• Be offered individual mentorship and career guidance by our faculty and be provided with regular feedback on theoretical and practical performance as well as personal development and the six core competencies by the faculty and core hospital personnel.
• Be offered specific preparation for the qualifying and certifying examinations in surgery, including the ABSITE Examination, Mock Oral Examinations and Board Preparation Course for senior residents.
• Be supported in their application for membership to the Candidate Group of the American College of Surgery upon successful completion of the residency and additional ACS requirements.

 

To address several important non-clinical and clinical issues in an ever-changing health care environment, the residents will be offered a one-year program of value-added post-graduate training, to be completed after the third clinical year. Residents will be informed about their choices during their first two years of residency*. A decision on the path of training will be expected one year prior to the start of the value-added year (end of PGY 2 year).

• The Business of Medicine: We support/pay for a one-year executive MBA program, designed to teach the basics of financial and business management, leadership, strategy and negotiation, operations, marketing, innovation, and so forth. This business degree will be offered at the Loyola College of Maryland, University of Baltimore/Towson University, Morgan State University or a similarly qualified institution.
• Public Health/Health Care Administration: We support/pay for a one-year MPH or MHS program, designed to teach the resident issues of epidemiology, public health and research (evidence-based medicine). This degree will be offered at the Johns Hopkins School of Public Health or a similarly qualified institution.
• Care of the Critically Ill Patient/Trauma: We support/pay for an in-residency one-year critical care/trauma fellowship at the renowned RA Cowley Shock Trauma Center or Johns Hopkins Hospital. This fellowship is designed to address the issues around the changing designation of "general surgeon" and the increasing community needs for high-level care of the critically ill, injured and emergency patients. The fellowship will enable the resident to sit for the certifying examination in surgical critical care after completion of all requirements.
• Research: We will offer and support an in-residency one-year research fellowship with a mentor in the Department of Surgery, affiliated department at Sinai and/or department at one of its affiliated institutions to promote the deeper understanding of unity between excellence of care and scientific pursuit.

* Prior to making any choices regarding the value-added year, residents will be given: 1) comprehensive written information on each option for the value-added year; 2) the opportunity to discuss with residents who have already undergone the value-added year their experiences and recommendations; 3) the opportunity to visit the Institution (for MBA, MPH, Critical Care Fellowship) and interview with key faculty; 4) the opportunity to discuss the options with the program director, associate program director and their faculty mentor and/or faculty of their choice at Sinai Hospital before making a choice on whether or not to opt out and/or which option to pursue.

Johns Hopkins Hospital	The Johns Hopkins Bayview Medical Center	The Alfred L DuPont Children's Hospital	R Adams Cowley Shock Trauma Center

The Johns Hopkins Hospital is one of the premier teaching institutions in this country. Sinai Hospital has a long-standing history of academic affiliation with Hopkins: The internal medicine residency at Sinai is fully integrated with Hopkins, medical students and fellows in various specialties rotate at Sinai throughout the year, and until the academic year 2005 up to 10 surgical residents from the Johns Hopkins general surgery residency program rotated full time at Sinai Hospital as one of the integrated training sites. The core general surgery faculty as well as faculty in various other specialties at Sinai all hold faculty appointments at Hopkins and are involved in collaborative research efforts.

As part of the Sinai Surgery program, residents will attend grand rounds, and the animal operatory lab at Hopkins on a monthly basis.

Two strategic rotations at Hopkins have been designed to complement the training of Sinai Surgery residents: As PGY III, the resident will join the solid organ transplant team, under the direction of Dr. Robert Montgomery. This rotation will expose the Sinai resident to the science and clinical practice of pancreas, kidney and liver transplantation at a high-volume academic center. The Sinai resident is an integrated member of the transplant team and will participate in a variety of basic science and clinical educational conferences and lectures. As PGY IV the Sinai surgical resident will spend six weeks on the plastic/head and neck surgery service at Hopkins. The chief, Dr. Paul Manson, is one of the fathers of plastic surgery and has created one of the busiest and most comprehensive divisions in the country. Services span the fields of trauma and oncologic reconstructive surgery, pediatric (including craniofacial deformities), burn and cosmetic plastic surgery. The Sinai resident, will be an integrated member of the team and interact with Hopkins residents and fellows in plastic surgery. The comprehensive array of core curriculum and other educational activities provides for a great experience. The chair at Hopkins, Dr. Julie Freischlag, and the division chiefs and faculty are fully committed to provide an outstanding educational experience for our residents.

 

Integrated into the Hopkins system, but functioning as freestanding hospital in East Baltimore, Bayview houses the state's burn center. The chief of the division, Dr. Stephen Millner, has an outstanding reputation in research and teaching. This rotation will provide the opportunity to learn cutting-edge, high-volume and high-severity burn care (including ICU) and reconstruction. Residents will be encouraged to participate in the division's active research effort and will be offered the opportunity to participate in a publication.

 

The RA Cowley Shock Trauma Center is one of the country's premier trauma centers. The Sinai Surgery resident (PGY III) will complement the trauma training received at Sinai at this high-volume (> 7,500 patients per year), high-ISS (mean > 15) center during a six-week rotation. During that time, the residents will have the opportunity to work and exchange ideas with surgery and emergency medicine residents, and trauma, anesthesia and critical care fellows from all over the country. The faculty is highly diverse, academic and focused on teaching. Educational activities include weekly M&M, resident core curriculum anatomy and other sessions, as well as certification in ATLS (PGYI), FAST (PGY II) and ATOM (PGYIII). Outside of the trauma and critical care experience, Shock Trauma houses one of the largest Hyperbaric Oxygen Centers in the country. The Sinai Surgery resident spends four weeks on the soft tissue service, where he or she will learn, in one-on-one training with the attending and highly experienced mid-level providers, the care of complicated soft tissue injury and infection.

In addition to this rich experience, as outlined in the section for the value-added year, our residents may choose to pursue a career in trauma surgery and critical care, by completing a one-year fellowship at the Shock Trauma Center after their PGY III year.

Also located at the University of Maryland Medical Center is the Maryland Advanced Simulation, Training, Research and Innovation (MASTRI) center where Sinai Surgery residents practice FLS skills and advanced laparoscopy simulation on a monthly basis.

 

Sinai Hospital has an active Pediatric Surgery service, but to enhance certain aspects of this experience (complex neonatal surgery, pediatric trauma, pediatric organ transplantation, adolescent bariatric surgery), the residents (PGY III) will rotate at the Alfred I duPont Children's Hospital as an integral member of the Pediatric Surgery team.

The duPont Hospital is the only children's hospital in the state of Delaware and also serves the populations of the Eastern Shore (Maryland) and New Jersey. The Pediatric Surgery Service cares for neonates, infants, children and adolescents with a variety of problems including congenital, neoplastic, infections and trauma, and organ failure. The Division of Pediatric Surgery performs over 1,400 operative cases per year, which include minimally invasive and adolescent bariatric surgery and pediatric organ transplantation.

The rotation will provide additional educational experience to the Sinai residents in the form of Pediatric Surgery specific M&M conferences, resident teaching conferences, pediatric tumor board, pathology and gastroenterology conferences and a monthly pediatric trauma conference. Dr. Kirk Reichard, the clinical director, before joining duPont Hospital, was a long-standing faculty member at Sinai and received numerous citations for his excellence in resident teaching. The division has an established track record of resident education (Jefferson University System) and the residents will participate in a comprehensive syllabus.