Clinical Experience and Rotations

Interns are the front line of surgical residents at SLU Hospital. Our five categorical surgical residents work with other surgical subspecialties, anesthesia, emergency medicine and preliminary residents. PGY-1 residents learn the basics of pre- and post-operative care of complex patients and how to evaluate new patients in both the inpatient and clinic hospital and outpatient settings. This builds a knowledge base that will carry them into their later years. The operative experience includes level-appropriate cases, with teaching by both faculty and senior residents. While they are at the forefront of patient care, there are dedicated operative experiences that allow PGY-1s to build their surgical skills. There are also opportunities to assist in complex cases to develop early exposure to challenging surgical pathology. The PGY-1 year includes rotations in Trauma, ICU, Acute Care Surgery, Transplant Surgery, Surgical oncology/Colorectal, Pediatric Surgery, Breast/Thoracic, and Vascular Surgery. Approximately three months are spent at Cardinal Glennon Children's Hospital taking care of and operating on pediatric patients. Additionally, there are approximately three months dedicated to night-float services, which allow a greater degree of autonomy with the supervision of a senior resident. Interns also occasionally have 24-hour call responsibility. The PGY-1 year allows residents to acclimate to the demands of surgical residency and become an integral part of the surgical team. This allows them to transition into the next level of residency.

Second-year residents see a sharp increase in their responsibility, autonomy in their patient care duties, and their care of critically ill patients. The first of the defining rotations of this year is the ICU Nights rotation. During this rotation, the resident spends at least two months caring for all the surgical patients in the SLU Hospital intensive care unit. In conjunction with the anesthesia critical care resident, they are the first responders to the complex issues of ICU patients during the night. They learn to take care of hemodynamically unstable patients, deal with routine and uncommon post-operative issues, and provide surgical evaluation of medical ICU patients. Residents become proficient in skills such as central line, arterial line, and tube thoracostomy placement. The ICU Nights resident is also an adjunct for trauma activations and serves to assist the chief resident with high-acuity trauma patients.

The second of the defining rotations includes the experience at SSM Health St. Mary’s Hospital. This allows the PGY-2 a unique position of being the sole one of two general surgery residents at the hospital for an approximately two-month period.  They run their service under the supervision of two attending general surgeons. They are exposed to a high volume of cases they would otherwise not be the primary surgeon on — as well as exposure to the obstetric population. This includes soft tissue, a variety of laparoscopic cases including cholecystectomies, appendectomies, ventral and inguinal hernias, as well as abdominal wall reconstruction. Call from home introduces residents to private general surgery and lends to emergency operative cases for acute surgical problems.

The second year also includes rotations at the Veteran’s Affairs hospital, which includes 24-hour in-house call responsibility as well as the opportunity to serve the veteran population. This includes vascular and general surgery, as well as an intense clinic experience to develop their evaluation of common surgical problems. The Burn rotation at Mercy Hospital allows residents to become experienced in burn care, which increases their breadth of experience. The year is rounded out by additional experiences in either the Trauma ICU, Breast/Thoracic, or Surgical Oncology/Colorectal services.

Third-year residents have an increased emphasis on operative experience to prepare them for their years as chief residents. This year serves as a bridge between the responsibility of junior residents and the rigors of senior residency. This allows them to become increasingly technically adept in the operating room. PGY-3 residents cover chief-level call when chief residents have days off, as well as serve as mentors to junior residents. Rotations include the VA Hospital, where they have increased operative experience as compared to the PGY-2 year. This year also includes a return to the Acute Care Surgery Service, which functions to improve their clinical decision-making and operative skills, as well as serve to assist other services with operative duties to broaden their experience. The year is rounded out with the Pediatric Surgery rotation at Cardinal Glennon, where they serve as the most senior general surgery resident on the service, manage NICU and PICU patients, and participate in more complex operations. A one-month elective aids in career exploration and intense experience in the resident’s field of choice.

Fourth-year residents are the most senior residents on their service and serve as the chief of their team. The goal of this year is to develop leadership abilities to manage their patients and guide junior residents. This year is concentrated on trauma, with a mix of two to three months of daytime trauma and two to three months of trauma night float. The day trauma chief is responsible for trauma activations, overseeing floor trauma residents, and operating in scheduled and emergent trauma cases. The trauma night float chief oversees the overnight PGY-1 and PGY-2 residents, and they are responsible for overseeing trauma activations, staffing consults for general surgery, assisting with ICU management, and operating on emergent cases. PGY-4 residents also serve as the transplant surgery chief and participate in liver, kidney, and pancreas transplantation as well as general surgical cases on cirrhotic and transplant patients. This year also includes the new endocrine surgery rotation at Mercy South.

The final year of training is geared towards further honing the trainee’s surgical, clinical, and leadership skills with the goal of preparing the chief resident for independent practice or fellowship training. Chiefs lead their services with the goal of mastering the highest level of operative complexity and autonomy. They serve as role models and educators to their junior residents by learning through teaching. Rotations of this year include the VA Hospital, Surgical Oncology/Colorectal, Mercy South endocrine, and SLU Acute Care Surgery. At the VA, chiefs lead junior residents through cases with attending supervision, while honing advanced general surgical and laparoscopic skills. SLU Acute Care Surgery sees the highest acuity of urgent and emergent patients, preparing trainees for whatever medical and surgical challenges they will encounter in their careers. The Surgical Oncology/Colorectal rotation provides for the challenge of complex hepatobiliary and gastrointestinal operations including laparoscopic, robotic, and open experience in both fields. The clinic experience across these rotations also prepares chief residents to excel in the outpatient component of their future careers. Together, these final clinical rotations allow graduating chiefs to not only feel comfortable in their future field but to also have the skills and confidence necessary to perform at their highest level in any setting.