Clinical training

Preoperative and postoperative care is stressed at the junior level (PGY-1 and PGY-2). During PGY-2, you also serve as a senior resident in the intensive care unit. Your training emphasizes basic science knowledge and the development of basic surgical skills.

You begin your operative experience with common general surgery procedures. On average, junior-level residents operate every other day; typical procedures include mastectomy, cholecystectomy, appendectomy, and herniorrhaphy.

At the PGY-3 and PGY-4 levels, your training emphasizes surgical technique and skill refinement. You perform more-complex operations such as gastrectomy, colectomy, aortic aneurysm repair, pneumonectomy, and hepatic and pancreatic resections.

At the PGY-5 level, you gain experience in the entire spectrum of straightforward and complex general surgical problems. You manage your service and all patient responsibilities and manage and teach junior-level residents and medical students.

Rotation schedule

Rotation descriptions

All general surgery residency training takes place at Mayo Clinic's campus in Florida, except for trauma and burns (which takes place at the University of Florida College of Medicine — Jacksonville) and pediatric surgery (which takes place at Nemours Children's Specialty Care, part of Wolfson Children's Hospital in Jacksonville).

Abdominal transplant surgery (PGY-2)

As one of the five largest liver transplant programs in the country, Mayo Clinic provides excellent exposure to the challenging and complex surgical and medical management of patients undergoing abdominal transplants. Time on the liver and kidney-pancreas transplant services is part of the curriculum.

You have the opportunity to experience both organ retrieval and procurement as well as assist during the transplant. You follow these patients after transplant and are educated on immunosuppressive practices.

Cardiothoracic surgery (PGY-3)

Extensive cardiothoracic and cardiopulmonary transplant experience is available during this rotation. Active involvement in general thoracic and video-aided thoracoscopic surgery is provided. You are also able to participate as first assistant in many cardiac cases. Involvement in organ retrieval and transplant is part of the rotation.

Colorectal surgery (PGY-1 through PGY-5)

This service consists of up to three attendings (senior resident and junior resident). This is one of the busiest services, as one of the three surgeons is typically operating each day. You are exposed to a variety of procedures, including all types of colon resection, transanal excision, and perianal problem management. This rotation involves experiences with patients with colon cancer, incontinence, and inflammatory bowel disease. Experience with laparoscopic colon resection is a key part of the rotation.

General surgery (PGY-1 through PGY-5)

The general surgery rotations are apprenticeships during which you rotate with each staff member as the only junior or senior resident on a particular service. You operate with the consultant, run his or her clinic, and assume responsibility for managing all patient care issues. Consultants have a particular field of expertise upon which they base the majority of their practice. These interests include endocrine, laparoscopy, foregut, hernia, gastrointestinal motility, and reflux.

Endocrine cases are composed of thyroidectomy, standard and minimally invasive parathyroidectomy, and laparoscopic and open adrenalectomy. Laparoscopic cases include Nissen and Toupet fundoplication, splenectomy, cholecystectomy, appendectomy, and esophageal myotomy.

In addition to these specialty cases, the general surgery department performs a large amount of basic general surgical procedures, including hernia repair and gastric and small bowel resections.

Hepatobiliary surgery (PGY-1 through PGY-5)

This rotation covers all aspects of hepatic, pancreatic, and biliary tree surgery. We have two dedicated hepatobiliary surgeons who each perform a large number of pancreatic and biliary cases. You learn advanced management of hepatobiliary cancers through clinical work-up, imaging, planning, treatment, and postoperative care. Experience in hepatobiliary laparoscopic procedures is a key part of the curriculum.

Intensive care unit (PGY-1 and PGY-2)

The intensive care unit is currently a combined medical-surgical unit. The experience consists of one month as a PGY-1 and one month as a PGY-2. You have a large amount of autonomy in patient management. At the PGY-1 level, you work with a senior resident or fellow when on call. At the PGY-2 level, you act as a senior resident when on call.

Your responsibilities include managing general surgery, abdominal and cardiopulmonary transplant, and cardiothoracic and medical patients. Extensive experience in infectious diseases and ventilator and hemodynamic management of surgical and medical patients is provided. You also have opportunities to perform procedures such as central venous line placement, tracheal intubation, percutaneous tracheostomy, and percutaneous gastrostomy procedures.

Pediatric surgery (PGY-3)

This rotation takes place at Wolfson Children's Hospital in downtown Jacksonville, a busy primary and tertiary care facility. You are exposed to the surgical management of pediatric patients on the floor and in the pediatric and neonatal intensive care units.

Emergency room consults, as well as basic and advanced procedures, are part of the rotation. Exposure to advanced pediatric laparoscopic procedures in neonatal, infant, and pediatric patients also is provided.

Subspecialties (PGY-1 through PGY-3)

• Gastroenterology. Extensive experience in esophagogastroduodenoscopy, colonoscopy, and esophageal dilatation is provided. Exposure to endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and photodynamic therapy also is available.
• Otorhinolaryngology. This includes cases involving microsurgery and extensive neck dissection.
• Plastic surgery. Reconstruction and closure of complex wounds and cosmetic reconstructive procedures and postoperative management are taught in both inpatient and outpatient surgical environments.

Trauma and burns (PGY-2 and PGY-4)

Performed at the University of Florida College of Medicine — Jacksonville for two months during PGY-2 and PGY-4, this rotation provides a full spectrum of emergency room and trauma care experience.

Exposure to penetrating and blunt trauma management of both adult and pediatric patients is provided. Experience in the admission and primary management of patients with burns is provided at the PGY-2 level. During PGY-4, you are chief of the trauma service and have your own surgical clinic. Extensive didactics are part of this rotation.

Advanced Trauma Life Support certification

You are required to become certified in the American College of Surgeons' Advanced Trauma Life Support program. If you have not completed this course prior to entry into the program, we provide this training at one of the regional centers.

Vascular surgery (PGY-1 through PGY-5)

The vascular service is managed by a PGY-3, PGY-4, or PGY-5 resident and a PGY-1 resident. The senior resident is responsible for supervising all aspects of patient management, and both residents participate in operating room activities. There is a wide variety of cases, including procedures in endovascular and open abdominal aortic aneurysm repairs, mesenteric revascularization, carotid endarterectomy, vascular bypass, and vascular access.

Continuity of care

Continuity of care is extremely important for both the patient's well-being and for resident education. Work rounds are held on all services at least twice a day; teaching rounds are conducted with the supervising faculty daily.

A unique aspect of Mayo Clinic's program is the institution's physician schedule. Physicians are paired on working teams and operate on opposing days. This scheduling permits surgical services to function as a team in both the hospital and outpatient clinic. It also allows you to participate in the total care of patients under the supervision of a faculty member.

Call frequency

Our interns fulfill call duties through a night float system. Each intern covers one week of nights at a time with all weeks evenly distributed. Mayo Clinic follows the recommendations of the Accreditation Council for Graduate Medical Education (ACGME).

Resident responsibilities

Your responsibilities vary according to the specific rotation and your level of training. Your supervising faculty member delegates and supervises all aspects of patient care, including diagnoses; preoperative, intraoperative, and postoperative care; and subsequent outpatient follow-up.

Operative experience

The operative experience of residents completing Mayo Clinic's General Surgery Residency is well within the guidelines of both the Residency Review Committee for Surgery of the ACGME and the American Board of Surgery. In 2012, the program at Mayo Clinic in Jacksonville, Florida, received the maximum certification of five years.

J. Wayne and Delores Barr Weaver Simulation Center

Mayo Clinic's campus in Florida recognizes the increasingly vital role that simulation plays in surgical education. In order to accommodate the needs of our residents, the new 9,000-square-foot simulation center was established in January 2013 with the help of a generous donation by J. Wayne and Delores Barr Weaver. The simulation center boasts high-fidelity skills trainers and simulation rooms for a wide variety of surgical tasks and scenario simulation.

Junior residents participate in a structured curriculum that is proctored by faculty from each surgical discipline. Training is provided for basic skills such as suturing and knot-tying as well as more advanced laparoscopy, endoscopy, robotic surgery, and simulated endovascular interventions.

The curriculum is designed to supplement, but not replace, technical training in the operating room setting. We believe that simulation of sound fundamental skills is an integral part of resident education. Our faculty adviser for the simulation center is John A. Stauffer, M.D.

Evaluation

To ensure you gain proficiency and develop the corresponding technical skills, your performance is monitored throughout this program. You are formally evaluated by your supervising faculty member following the completion of each clinical rotation and then meet with the program director to review these evaluations. In addition, you regularly evaluate the faculty to ensure your educational goals are being met.