‘State of the Program’ – Welcome to 2012/13!

Hi guys,

Welcome to the 2012-2013 academic year! And an especially warm welcome to the new R1s, who, by all accounts, have hit the ground running. We have already heard great things about you. We are looking forward to working with you and to making you feel like part of the family. Please ask us lots of questions and always feel free to get help whenever you need. Your senior residents, attendings, and program directors always want to know how you are doing and what’s going on with you.

We are excited about this year, and we think it has the potential to be one of the best years ever for the program. Besides having a phenomenal group of residents, we also have a new and more comprehensive curriculum, new skills sessions, new ways to evaluate knowledge and technical skills, new rotations, and evolving strategies for engagement in research and global health. All of these new initiatives and refinements have been driven by your experiences and comments at last year’s Town Halls and retreats, and during our 1 on 1 meetings. We loved having these discussions with you all and we are looking forward to continuing them as the program moves forward to accreditation in the fall of 2013. Our goal is to be amazing at the Royal College review, and to establish the program as among the very best in North America.

We have included brief descriptions of some of these initiatives below. There is obviously lots more to say about this stuff, and we look forward to an ongoing dialogue with you.

AHDs

As you are aware, this year we will be piloting the split Academic Half Day format, with junior AHDs on Wednesday mornings and senior AHDs on Thursday afternoons. Our commitment as a Program is for all of you to complete a major surgical textbook this year (Current for juniors, and Schwartz for seniors). This is about a chapter per week. Please make reading a part of your everyday routine. We have advised your teaching faculty that you will be coming to the sessions prepared, and we have asked them to bring cases and to incorporate mock oral exams into the sessions. This year, almost every AHD will tackle “core content”, and there will be very few breaks in the pace of reading assignments. CanMEDS and other non-Medical Expert AHDs will be incorporated into these core AHDs where relevant. In general, AHDs will continue to be scheduled for 3 hours, with 2 hours of group teaching, and a third FLEX hour, that will be used for simulation, CanMEDS content, research, enrichment activities, and testing, depending on the week. In the split AHD format, the AHDs are more mandatory than ever. Please sign out, be on time, and plan to be away for the full time. All absences must be cleared in advance with us. This is a matter of professionalism and respect for your colleagues and faculty. Finally, please carefully evaluate each and every AHD, and consider nominating a particular AHD series for Block of the Year.

Skills sessions

The Program will continue to place a strong emphasis on simulation. The juniors will use their technical skills time to complete modules from the Fundamental Laparoscopic Skills Course, while the seniors will continue to attend the high fidelity human and cadaver labs, with focus depending on the AHD block. We will be holding time trials at intervals through the year – we need all of your MIS times for your Dashboards. If you haven’t posted a time yet, it is up to you to get one in before your next progress review meeting. Training on the endoscopy simulator is also essential for all residents starting an endoscopy rotation. All of you need to complete 50 scopes on the GI Mentor before starting your endoscopy rotations.

Skills courses

As always, you will have access to the SAGES courses in the US and Canada. The invitations to these courses for juniors and seniors come out throughout the year, so please watch for them, and reply to us as soon as you can. We will nominate residents for these courses on a first come, first served basis. If you go, please send us a brief 1 paragraph synopsis of your experience so we can keep track of who went, what was covered, and what was valuable. The R1s will be getting the ATLS, FCCS, SRAT, and ACS Basic Ultrasound courses, as well as a new Perioperative Emergency Management (POEM) course as part of CRASH. The R6s will be funded for a GS review course, and hopefully for the Definitive Surgery for Trauma Course (DSTC) in the months leading up to the Royal College Exams. Please sign up for DSTC as soon as it becomes available – last year, one of our residents was too late to get a spot.

Testing

There are going to be quite a few tests this year. Everyone will be getting about 5 brief Progress Tests based on the readings. The format of these tests will vary, but will include MCQs, short answer, and anatomy. We will also be running 2 Practice Oral Exams (December and June) as usual, also based on readings. As noted above, we will be measuring and recording knot tying times as well. The R1s get a CRASH exam and OSCE, the R2s the LMCC 2 and POS, and the whole Program will write the CAGS Exam in the spring. We know that this is a lot of testing, but the Progress Tests will be more manageable and meaningful than the semiannual tests we used to have. We will use your results to check on your progress, but, don’t worry, no one will be dismissed from the Program based on in-training exam results.

Case Logs

Please log your cases and stay current. We watch the Operative Dashboard closely. Also, GRITS forms are part of the Dashboard now. Seniors, please get these completed on all index cases, and log them on T-Res in the appropriate blank if you have achieved independence on a case.

New rotations

DI: The Emergency Trauma Diagnostic Imaging rotation for R3s is up and running, and the first resident through felt that it was valuable. The rotation focuses on emergency radiology, abdominal imaging, RIPIT, FAST and interventional procedures. Please come and see us before you start, in order to review the goals, objectives and resources for this rotation. Residents completing this rotation are encouraged to do their own FAST exams as Trauma Seniors. We are also looking in to buying some hand held U/S units for the ACS Seniors, to keep your skills in abdominal imaging fresh.

MIS / Endo: R3 Seniors are back on the MIS Service this year, with an added focus on GI Endoscopy. We are sure you guys know that there is a huge turf war going on locally and nationally over endoscopy, and we are in the middle of it. All of you MUST take every opportunity to maximize your exposure to scoping, on every rotation where surgeons are doing scopes. The MIS / Endo rotation is one such opportunity. Please scope, and evaluate the rotation in part according to scope access.

Ambulatory Surgery:  This is a senior rotation focusing on diagnostic and therapeutic decision making as well as communication skills in the outpatient setting.

Final Block: In keeping with the expectations of the Royal College, the program will ask graduating residents in their final three months of training to take on some nominal on call responsibilities at VGH and SPH.  Call expectations will be minimal but will hopefully keep residents’ exposure to acute surgical issues up to date.

ACS changes: We are working on some organizational changes on ACS to try to correct some longstanding issues. We have also made some changes to enhance the educational experiences of the medical students and juniors on the service, including more focused mentorship, more bedside teaching, and more structured didactic and case-based rounds. Some of these changes will be implemented by the new ACS teaching fellows. All this is evolving, so more later.

Rotation evaluations: You will notice that many of the rotation evaluations have been tailored to your rotations and level of training, and there are more rotation specific evaluations on the way. We have streamlined the evaluations, changed the scoring system a bit, and enhanced the ability of the forms to pick up on exceptional performance.

Research

All of you are expected to get involved in research, quality improvement, or leadership activities. This is an especially crucial year for the R2s, who will have to decide how to use their research months, and whether to apply for salary support to pursue research years. At minimum, we expect all R2s to present research proposals at Residents’ Research Day in May. However, all of you are encouraged to consider taking a research year after the R2 or R3 year. Please speak to us or to Dr. Stephen Chung soon about available opportunities. And keep talking to potential mentors about what they are doing, and about how you might get involved. But don’t commit right away. Wait until you find something good.

Global health

This year, we will formalize the structure of our Global Health Scholars Program. All of you have had, and will have, access to global health teaching activities at AHD, teaching rounds at the Branch for International Surgery (BIS), on-line graduate level courses through the BIS, overseas trips and electives, and full masters programs through the UBC Clinical Investigator Program. You guys can choose components of this Global Health Scholars program according to your interest and career goals.

Social events

Please plan on attending the Residents Day Dinner and Graduation Day. We’ll send you the dates way ahead of time. We need you all throughout the year to talk to prospective applicants to the program, and to attend CaRMS Interview Day in various capacities. Most importantly, find some time to chill together. The journal clubs, even if you only had time to skim the abstracts, have been awesome events, and I think that everyone should do their best to go to those. Last year’s inaugural Residents’ Retreat was amazing as well, and this year’s may be even better, thanks to all of your input and enthusiasm. Finally, the residents used to go out together after AHDs on Thursdays. Anything you want to do, let us know and we will do our best to support it.

Communication

Communication is a key priority this year, and we will try to be clear about our expectations, and about what’s happening in the Program. Remember to check the website regularly for updates. We will also need a resident rep from each year on the GS Residency Education Committee. Please nominate someone from your group within the next 1-2 weeks. Then check with your rep if you want the REC to address a program issue. As Curriculum Committee chairs this year, Yasmin and Sarah have automatic membership on the REC. The Program Directors will also meet with you twice a year, and whenever else you want, including during our Thursday afternoon office hours. Please let Heather know when you want to come, or just stop by anytime. And we are always reachable by text and email, and we always want to hear from you.

This may be the longest email we have ever written and we apologize. We mainly wanted to welcome everyone to the next year of their training. It’s another huge landmark in 45 brilliant careers, and worth celebrating and being proud of. To be the best program in North America, we have to train the brightest and best surgeons in North America. With all of you guys around, we have a shot.

Morad and Sonia

a place of mind, The University of British Columbia

General Surgery Residency Program
Room 3100 - 910 West 10th Avenue,
Vancouver, BC, V5Z 4E3,
Tel: 604 875 4133
Fax: 604 875 4036

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