Over the past academic year, our General Surgery Residency Program at Mount Sinai Medical Center has continued to advance and adapt, achieving notable successes and implementing significant changes to enhance resident education and wellbeing.
Two of the chief residents have entered private practice, underscoring the solid foundation and comprehensive preparation provided by our program. The remaining chief resident has secured a position at a major medical center to pursue a Vascular Surgery fellowship. Additionally, all three chief residents successfully passed their American Board of Surgery certifying examination.
Our Robotic Surgery curriculum has been significantly expanded with the addition of a third Da Vinci Xi Platform, including a Teaching Console for educational purposes. This expansion allows residents to gain comprehensive robotic surgical skills through online, simulator, and hands-on training. The integration of robotic techniques into colorectal and general surgery services has been well-received by both faculty and residents. We have a set curriculum for each PGY level.
The chief resident rotating on the GI Surgery service continued to manage a team of residents caring for patients who have had complex foregut/bariatric surgery, colorectal surgery and hepatobiliary surgery. On this particular service the chief resident, and the rotating residents, will have an opportunity to care and operate on patients with esophageal/gastric malignancy, hiatal hernias, reflux, achalasia, anorectal pathology, inflammatory bowel disease, colon /rectal cancer, liver and pancreatic disease. The chief resident will be involved in the management of all patients on this service and will perform complex foregut surgeries, bariatric weight loss surgeries, hepatobiliary surgeries such as liver and pancreatic resections via laparoscopic and open approaches. Approximately 4-10 major hepatobiliary surgeries are performed per month including pancreaticoduodenectomy, distal pancreatectomy, and formal/non anatomic liver resections. Chief Residents will perform approximately 10-12 Pancreaticoduodenectomies (Whipple) upon graduation. The average case volume per month is approximately 80-100 major cases and 50-75 colonoscopies/upper endoscopies. Four attending surgeons make up this service. Dr. Hochwald was hired as our new Chief of Surgical Oncology Section and Director of our Comprehensive Cancer Center adding further expertise to our resident education.
We continued with our Dembrow rotation for our surgery residents giving them a unique exposure to head and neck oncology including thyroid/parathyroid pathology as well as neck dissections, laryngeal cancer, and head/face/neck basal cell/squamous cell/melanoma. Consequently, our surgical residents will each typically graduate with 40-50 thyroid/parathyroidectomies/parotidectomies and 15-20 neck dissections. Additionally, all aspects of breast surgery are performed on this service with exposure to plastic/reconstructive surgery. This service is managed by a PGY4 who oversees a team of junior residents. We currently have three dedicated board-certified surgeons who oversee this entire service.
The chief resident on the Vascular Surgery manages a team of residents who treat all acquired peripheral vascular disease and dialysis access via open and endovascular techniques. We now have 5 vascular surgeons dedicated to teaching our residents on this service. On this service the residents have an early exposure to vascular surgery, angiography and endovascular techniques is afforded to the junior residents. Advanced skills of open vascular surgery are available to chief level residents, such as carotid endarterectomy, lower extremity endarterectomy and bypass, and abdominal aortic aneurysm disease. This allows our chiefs to graduate with an average case volume of 200 major vascular cases. Every Thursday our residents attend a mandatory educational Vascular Surgery conference to discuss their upcoming surgical cases,
The chief resident rotating on the Manheimer General Surgery Service is responsible for a team of residents who cover the majority of elective general surgery and acute emergency general surgery cases including bowel resections, laparoscopic and open complex hernia repair, colon resections, gastric perforations, and other acute abdominal pathology. We have hired two additional general surgeons to complement the current 4 busy general surgeons. The average case volume per month is approximately 125 major cases among 6 attending surgeons which include appendectomies, cholecystectomies, common bile duct exploration, inguinal and ventral hernia repairs, upper/lower endoscopies, PEG tube placement, tracheostomies amputations and soft tissue excisions.
Our Robotic Surgery curriculum has expanded to include colorectal as part of our GI and General Surgery Services. We recently added a third DaVinci Xi Platform with a Teaching Console for educational purposes with the goal to expose general surgery residents to the robotic platform. The resident robotic curriculum requires to pass online and simulator training prior to operating on the console. Our surgery residents continue to practice on our Academic da Vinci Trainer which affords them full access to this education platform. They are able to perform many simulated surgical procedures based on personal level of achievements. This has been well received by all the faculty and residents.
Dr. Sumana Narayanan has been a great Associate Program Director and Chair of the Clinical Competency Committee. Her expertise as a fellowship-trained Surgical Oncologist has been instrumental in advancing resident education and evaluation. Additionally, we continue to implement a mandatory mentor/mentee program, which includes dedicated sessions at the beginning of each academic year and encourages monthly meetings between residents and their mentors.
To support resident well-being, we have established a wellness program providing each resident with six hours of time off per month during weekdays. This time is designated for personal appointments and self-care, which has been positively received and contributes to overall resident satisfaction and wellness. This has worked very well for us and we continue to have dedicated lectures by professionals regarding this very important topic. We have successfully transitioned many didactic teaching conferences back to in-person formats, including weekly morbidity and mortality conferences and journal clubs, at the request of our residents. Additionally, mandatory multidisciplinary oncology tumor boards continue to be held via video conferencing, ensuring ongoing educational engagement.
Overall, the past year has been marked by significant achievements and advancements in our residency program. We remain committed to continuous improvement and excellence in surgical education.
We have 7 Surgical Teaching Services at Mount Sinai Medical Center, Miami Beach, FL.
- Manheimer General Surgery
- The service that covers the majority of the emergency room call performs general surgery including laparoscopic and open complex/advanced hernia repair.
- Average case volume per month is approximately 100 major cases distributed among 5 attending surgeons. On average per month the following cases are performed: (15) appendectomies, (30) cholecystectomies, (25) inguinal & ventral hernia repairs.
- Additionally all other aspects of general surgery and endoscopy are performed including: PEG tube placement, amputations, soft tissue excisions, colon resections, and emergent interventions for acute abdominal pathology.
- Dembrow Surgery
- Unique exposure to head and neck oncology including thyroid/parathyroid pathology as well as neck dissections, laryngeal cancer, and head/face/neck basal cell/squamous cell/melanoma is obtained in large volumes and unique for any general surgery program. Residents will typically graduate with 40-50 thyroid/parathyroidectomies.
- All aspects of breast surgery are performed with additional exposure to plastic/reconstructive surgery available as desired by the resident.
- 3 attending surgeons make up this service. Average case volume per month is approximately 80-100 major cases.
- GI Surgery
- This service comprises surgical oncology, complex foregut/bariatric surgery, and upper and lower endoscopy.
- 5 attending surgeons make up this service. Average case volume per month is approximately 140 major cases and 50-75 colonoscopies/upper endoscopies.
- Colorectal surgery comprises a stable and growing volume of all pathology: anorectal, inflammatory bowel disease, elective and emergent colon resections, and screening colonoscopy.
- Complex foregut surgery such as: bariatric weight loss surgery, esophageal/gastric resections for malignancy, hiatal hernia repair, fundoplication/antireflux operations, and heller myotomy.
- Hepatobiliary surgery such as: liver and pancreatic resections via laparoscopic and open approaches. Approximately 4-10 major hepatobiliary surgeries are performed per month including: pancreaticoduodenectomy, distal pancreatectomy, and formal/non anatomic liver resections. Chief Residents will perform approximately 10-12 Pancreaticoduodenectomies (Whipples) upon graduation.
- Vascular Surgery
- This service comprises treats all acquired peripheral vascular disease and dialysis access via open and endovascular techniques.
- Early exposure to vascular surgery, angiography, endovascular techniques is afforded to junior residents while the and the advanced skills of open vascular surgery are available to chief level residents such as: carotid endarterectomy, lower extremity endarterectomy and bypass, and abdominal aortic aneurysm disease.
- All minimum requirements are easily exceeded preparing you for emergency vascular repair/exposure in trauma scenarios or applications vascular surgery fellowship placement.
- Average case volume upon graduation 250 major vascular cases.
- Cardiothoracic Surgery
- This service comprises another growing division and has 5 attending surgeons who treat acquired cardiovascular and pulmonary disease with traditional, minimally invasive, and endovascular techniques. Each year approximately 600 open heart surgeries, 100 Transcatheter aortic valve implantation, and 300-400 thoracic oncology cases (pulmonary resection, interventional airway, esophageal/foregut) are performed.
- Senior residents on this service acquire directed learning towards managing acute chest pathology and surgical critical care from the perspective of post-cardiotomy shock and complex cardiopulmonary derangement. Daily rounds include significant surgical critical care while operative exposure complements the practice of general surgery/trauma surgery and/or prepare you for cardiothoracic surgery fellowship application.
- Surgical Critical Care at MSMC
- This service comprises 4-5 surgical intensivists who care for all post-operative surgical patients in the Surgical ICU at MSMC. They primarily care for post-operative cardiothoracic, general, and vascular surgery patients who demonstrate coagulopathy, all forms of shock, and the dysfunction of all solid organs.
- All ICU pathology is represented and residents will learn specific skills from critical care trained physicians such as: central/arterial line placement, temporary dialysis access, swan-ganz catheter placement, chest tube insertion, intra-aortic balloon pump/ECMO management, ventilator management, bronchoscopy, resuscitation, and sedation management.
- Excellent surgical outcomes include detailed post-operative management and residents are allowed dedicated SICU rotations where they can focus on this management to complement their surgical practice.
- Night Float at MSMC
- The night float system was designed to allow a consistent team of 3 residents (PGY3/4, PGY2, PGY1) to manage all of the surgical patients at night, function as a team with one senior resident in charge of all overnight consultations and patient care, cover evening cases (after 6-8pm), and allow other residents time to focus on their respective services. Night residents always have Chief Resident and Attendings on home call for supervision.
- Broward General Medical Center, Fort Lauderdale, FL.
- Trauma Surgery and Surgical Critical Care
- Residents rotate at Broward General Medical Center, a Level-I Trauma Center, in downtown Fort Lauderdale for a total of approximately 7 months (3 months as PGY2, 4 months PGY 4) to obtain a good exposure to trauma surgery and surgical critical care.
- Residents will treat patients with penetrating and blunt trauma and will easily exceed all minimum requirements for operative and non-operative trauma and team leader resuscitation.
- PGY-4 Residents act as Chief of the trauma surgery service and manages all aspects of care for these patients including: initial trauma bay evaluation, all operative trauma cases, all aspects of complex surgical critical care (ventilator management, tracheostomy, invasive tubes/lines, mass transfusion protocol). Skills acquired here translate into elective and emergency general surgery. Opportunities for research/publication are also available for those interested in pursuing fellowship.
- Additional Outside Rotations
- Pediatric Surgery at Nicklaus Children’s Hospital
- MSMC residents rotate on Pediatric Surgery with an established, busy group of Pediatric Surgeons which affords an early and thorough exposure to this specialty including neonatal to adolescent cases. All operative requirements are met within this time frame with potential for an additional senior resident rotation as our complement increases.
- Burn Surgery at Ryder Trauma Center/Jackson Memorial Hospital, Miami, FL.
- MSMC residents spend one month learning the unique specialty of Burn Surgery with well-established trauma & burns specialists. This affords significant experience with critical care management, fluid resuscitation, in addition to operative debridement and grafting.
Our Program has recently expanded our complement to graduating 3 Chief Residents per year beginning with the Class of 2019. Currently we have 20 Residents in our Program:
- (3) Chief Residents
- (3) PGY-4
- (3) PGY-3
- (5) PGY-2
- 3 Categorical Positions
- 2 Preliminary Positions
- (6) PGY-1
- 3 Categorical Positions
- 3 Preliminary Positions
Rotations
- PGY-1 Year
- General Surgery: Mount Sinai Medical Center (5 months)
- Cardiothoracic Surgery: Mount Sinai Medical Center (1 month)
- Vascular Surgery: Mount Sinai Medical Center (2 months)
- Burn Surgery: Jackson Memorial Hospital (1 month)
- Pediatric Surgery: Nicklaus Children’s Hospital (1 month)
- Night Float: Mount Sinai Medical Center (2 months)
- PGY -2 Year
- General Surgery: Mount Sinai Medical Center (3 months)
- Vascular Surgery: Mount Sinai Medical Center (2 months)
- Trauma Surgery: Broward General Medical Center (3 months)
- Surgical Intensive Care Unit: Mount Sinai Medical Center (1 months)
- Night Float: Mount Sinai Medical Center (2-3 months)
- PGY-3 Year
- General Surgery: Mount Sinai Medical Center (6 months)
- Vascular Surgery: Mount Sinai Medical Center (2 months)
- Thoracic Surgery: Mount Sinai Medical Center (1 month)
- Night Float: Mount Sinai Medical Center (3 months)
- PGY-4 Year
- General Surgery: Mount Sinai Medical Center (5 months)
- Transplant: Jackson Memorial Hospital (1 month)
- Trauma Surgery: Broward General Medical Center (4 months)
- Thoracic Surgery: Mount Sinai Medical Center (1 month)
- Night Float: Mount Sinai Medical Center (1 month)
- PGY-5 Year
- General Surgery: Mount Sinai Medical Center (12 months)
- 4 months of Vascular Surgery
- 4 months of GI Surgery
- 4 months of General Surgery
