Program Overview
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Training Program History
The development of surgical training at Palmetto Health Richland dates to 1938 when the Columbia Hospital (forerunner to Palmetto Health Richland) served as the sole training venue for postgraduate educational programs. In 1972, the program moved to the newly built Richland Memorial Hospital facility. A full-time director of surgical education was recruited to transform a purely community-based surgical training program to one with strong academic roots.
The University of South Carolina School of Medicine opened in 1979 and postgraduate surgical training became a cooperative effort of the school's academic Department of Surgery and Palmetto Health Richland. The full-time academic faculty of the Department of Surgery assumed the primary teaching responsibilities for resident and student education.
The addition of the William Jennings Bryan Dorn Veterans Affairs Hospital (DVAH) in 1976 as an integrated teaching hospital expanded the clinical opportunities for resident education. The surgical faculty of the DVAH was jointly appointed as faculty of the USC School of Medicine Department of Surgery, a relationship that persists today. The addition of this second training campus allowed the expansion of the categorical training positions from two to three.
Richland Memorial Hospital and Baptist Medical Center merged in 1998 to become Palmetto Health with the goal of improving the availability and quality of health care in the Midlands of South Carolina. Palmetto Health remains firmly committed to postgraduate medical education.
Goals for surgical resident education...
- To provide an educational environment enabling each resident to reach his or her maximum potential as a doctor and surgeon
- To assist the resident's maturation into a dedicated health professional committed to the improvement of the global health of the community
- To encourage academic growth and intellectual curiosity
- To hone educational skills for independent, life-long learning
- To foster an understanding of basic science and clinical research
- To provide fundamental education in the field of general surgery from which a surgeon may 1) enter the private practice arena with confidence, 2) pursue further specialty training or 3) enter academic surgery at the high level of performance expected of a board-certified specialist
Individual requirements for successful completion...
- Highly motivated and intelligent physicians forming the resident staff
- A commitment to accepting responsibility for one's own education
- An adequate volume and diverse spectrum of surgical disease generally encountered in general surgical practice
- State-of-the-art medical facilities
- A dedicated faculty committed to developing a standard of excellence in patient care, education and research
- Sufficient exposure to surgical specialties to produce a well-rounded general surgeon
Training
Resident education at Palmetto Health Richland and USC is structured to give the surgical resident graduated clinical responsibility throughout the five years of training commensurate with the maturation of their psychomotor skills and clinical judgment.
The resident will acquire the cognitive skills required for the practice of general surgery by completion of the written curriculum, independent and group study, and peri-operative management of surgical patients under the supervision of the surgical faculty and senior-level residents. Operative skills are developed beginning in the first year of postgraduate surgical training with residents in the first two years performing approximately 250 operative procedures supervised by full-time and clinical faculty.
Senior-level residents assume increased independence in patient care decisions and operative, however the faculty continues to provide an appropriate level of supervision. Graduates of the program report an average of 950 (in 2008) operative cases to the American Board of Surgery, meeting the minimum requirements for all defined categories in general surgery, including surgical critical care and endoscopy.
Teaching Responsibilities
All residents are expected to accept responsibility for their own education and for the education of their colleagues, subordinates and medical students of the University of South Carolina. Residents are expected to commit sufficient time to facilitate the achievement of educational objectives for the student's core surgery rotation through informal group discussions and one-on-one interactions. Senior residents are expected to provide educational leadership for the resident staff through formal student didactic sessions/group discussions, presentations at Morbidity and Mortality Conference and Grand Rounds and to serve as co-discussion leader with a faculty mentor during Journal/Study Club activities. Assessment of the resident's teaching efforts constitutes a significant portion of the resident's periodic performance evaluation.
The Resident Staff
Twenty residents were appointed to the resident staff in July 2012, a full complement. The number of resident applicants for the three categorical training positions offered has increased each year. The academic prowess of the applicant pool has increased yearly as reflected in USMLE scores (mean 220 for Step I and 221 for Step II) and the residents' performance on the American Board of Surgery In-Training Examination. Residents of the program have represented 53 medical schools and 30 States.
The academic productivity of the resident staff is reflected in the papers and presentations authored or co-authored by residents. These works represent a spectrum of clinical and basic science research. Expenses are paid for residents (at any level) to present their academic efforts at state, regional or national meetings.
Evaluation of Residents
Constructive assessment and appraisal of performance is essential to provide direction for optimal growth in both cognitive and psychomotor skills and attitude/professionalism. Formal evaluation of the resident's performance occurs at the end of each rotation based on specific educational and performance objectives developed jointly by the resident and faculty mentor at the commencement of the rotation. Progress through the general training curriculum is monitored as well. Residents are expected to meet with their faculty advisor as often as desirable/necessary, but at least every other month to formally review the progress made, areas needing additional effort and progress with the independent research project. Summary evaluations are provided (both written and verbal) bi-annually by the resident's faculty advisor and the Program Director/Department Chairman
The ABSITE examination is given each January. A departmental standard of performance has been established and failure to perform at that level may result in academic probation, development of a program of remediation or, if repetitive, suspension from the program. A departmental examination is administered in the fall of each academic year. Performance expectations are developed jointly between the resident and their faculty advisor.
Didactic conferences, journal club, textbook review, technical surgical laboratory training, simulation/skills laboratory training and directed independent study activities have been constructed to assist the resident in developing the cognitive and psychomotor skills required for competent surgical practice. However, independent study remains the cornerstone for successful academic achievement.
Residents are expected to submit anonymous evaluations of their clinical rotations and their faculty member's performance as an educator at the conclusion of each rotation.