Curriculum and Program Design
Harlem Hospital Center
The General Surgery Residency Program at Harlem Hospital Center is a fully accredited program with three categorical residents at each PGY level and nine preliminary residents at PGY1 and II. It is integrated with the Department of Surgery at Woodhull Hospital which is a community hospital like Harlem and affiliated with Memorial Sloan Kettering and New York Presbyterian Hospital for rotation in Surgical Oncology and Transplant Surgery respectively.
At Harlem Hospital Center, there are two general surgery services, with specialty services available in Neurosurgery, ENT, Vascular Surgery, Chest Surgery, Urology, Pediatric Surgery and Plastic Surgery. Orthopedic Surgery is a separate department. Each of the services has its own clinics and operating room schedules.
The goal of the program is to prepare residents for practice in surgery; therefore, the program is dedicated to training residents to become competent in the management of patients, to develop good technical skills and to acquire adequate surgical knowledge. The residents are taught that patient care includes being compassionate and truthful, establishing a good relationship with their patients and exhibiting behavior which gives good credence to the surgical profession.
Areas of Competency
To achieve these goals, the residents are evaluated to show competency in the following 6 areas:
- Patient Care
- Medical Knowledge
- Practice-based learning and improvement
- Interpersonal and communication skills
- Systems-based practice
To meet these criteria, different tools have been developed to evaluate residents in these competencies, which will help to prepare the residents, in their 5 years of clinical training, to become independent, competent and humane surgeons.
It is the responsibility of the Advisory Committee under the leadership of the Program Director to review the implementation of these tools, to appraise the effectiveness of the tools and to suggest changes to improve them. The residents are made aware of these objectives and are active participants in the appraisal of the effectiveness of the tools being utilized. The Chief Residents are members of the Advisory Committee. All Residents and Faculty meet once a year at the annual retreat to evaluate the goals and objectives of the program.
The department emphasizes that the patient and the patient's family are customers who when treated well, will continue to have care in our hospital and will refer others. It is expected that the residents show respect and empathy towards the patient. They must appreciate the needs of their patients, be receptive and make the patients feel at ease in expressing their needs, telling their story and asking questions. A personal connection at a professional level with the patient and family is of utmost importance.
All residents are expected to have an in-depth knowledge of the fundamentals of basic science of surgery.It is also important to apply this knowledge in clinical practice in a way which will optimize the use of the advances in medical technology (in investigations, invasive procedures, operative procedures etc.) while remaining cognizant of the cost of these advances in order to achieve optimal patient care.
Communication is essential, communication not only with the patient and family but also with healthcare professionals. The preventive health system is also an important part of patient care.
It is essential for the residents to be made aware of the use of simple non-technical languages easy for the patients to understand when explaining the patient's condition, the rational for diagnostic and/or operative procedures, the risk, benefits and alternatives, the plan of management and the follow up care.
ACGME Competency Outline
To achieve these goals, the program has adopted the outline by the ACGME, which reads as follows:
The residency program requires its residents to obtain competencies in the 6 areas below to the level expected of a new practitioner. Toward this end, the programs defines the specific knowledge, skills, and attitudes required and provide educational experiences as needed in order for their residents to demonstrate:
- Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
- Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
- Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
- Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
- Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
- Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
Conferences and Lectures
There are department-wide structured learning experiences provided for the education of surgical residents. These are:
The Morbidity and Mortality Conference and Director's Grand Rounds
These are time-protected conferences held on Wednesdays from 7:00 to 8:30 a.m. The first hour is for review of all morbidity and mortality cases. The purpose of this conference is to discuss on a department-wide basis the most difficult and challenging cases performed in the services during the preceding week, including interesting cases and all morbidity and mortality cases, with a view to¬ward stimulating the highest possible level of academic debate. The chief residents under the su¬pervision of the section chiefs are responsible for the organization of the conference. Participation by the Departments of Radiology and Pathology occurs as needed.
The Basic and Clinical Science Conference
This time-protected conference covers the core basic and clinical science subjects in general surgery. It is given by members of the Department, guest speakers and the residents under the supervision of selected attendings. It is held on Fridays from 6:30 a.m. to 7:30 a.m.
This also is time-protected and held on the 4th Friday of the month. A review of selected articles by residents is assigned including critique, suggestions and detailed discussion, always under the supervision of selected attending staff. The residents are expected to review journals and textbooks such as: a. Annals of Surgery b. Surgery c. New England Journal of Medicine d. Journal of American College of Surgeons e. Lancet f. Principles of Surgery – Schwartz g. Textbook of Surgery – Sabiston h. Care of the Surgical Patient - American College of Surgeons Conferences and Lectures
The resident review the SCORE Curriculum and go through Multiple Choice Questions in the SCORE on Thursdays from 6:30 am - 7:30 am.
Tumor Board Conference
This is held on selective Wednesdays from 1:00 p.m. – 2:00 p.m. It is a multi-disciplinary conference in which patients with cancer are presented and management decisions are made.
The residents have been assigned mentors who meet with the individual resident periodically to discuss their future plans, help with their work both clinical and non-clinical and advise them as needed to achieve their future goals. Mentors monitor their assigned residents for any evidence of stress.
Attending on call the night before and the attending on call current day meet with the residents at 7:00 a.m., using the sign out form for the program, to go over all the patients on the General Surgery services including new admissions. This helps to review all cases and discuss with the residents the management plan for the day.
Chief Resident Rounds
These take place in the morning before operating room and clinical activities and are oriented towards patient care. The afternoon chief residents rounds are more detailed and teaching oriented.
The residents duty hours are formulated to be in compliance with both the ACGME requirements and the Bell 405. There is security provided by hospital police 24/7 with installation of cameras at vantage points in the hospital and monitored 24/7. There is also parking available for residents. The residents are provided with a Resource Center and on-call rooms. The resource center has a microwave, refrigerator, computers with internet access for electronic retrieval of medical information, lockers for all residents, sturdy bookcase for textbooks, rack for hanging coats and center table with chairs.
The on call rooms are gender specific, have single beds and have dividers with curtains to give residents privacy. The rooms have two or three telephones, the doors have electronic access to provide extra security and they are close to the work areas of the residents with readily accessible computers
The residents also have transport services 24/7, there is phlebotomy service from 7:00am till 12 midnight every day, EKG technician are available 24/7. The nurses have been trained to start IV’s. Hence when there is a need for a peripheral intravenous access, the nurses are the first responders. The residents are called to perform the difficult sticks most of the time. The residents have been provided with food stipend in their bi weekly salaries. The institution has negotiated with some vendors for delivery of food on site until 11:30pm each day.
The Institution has provided the residents with Electronic Medical Records (EMR) which allows them to document and retrieve all patients information with ease. This allows for good quality patient care, residents education and a resource for scholarly activity.
The Department tries to make the work environment as friendly as possible, to limit the work load and to make the residents concentrate on the clinical activities as much possible.