First and Second Year
Junior residents start their surgical experience on the “core” services where they quickly build fundamental technical skills while learning to manage a myriad of peri-operative conditions. We divide the year into 13 blocks, 4 weeks each in length. First year includes rotations on core surgical specialties of elective general surgery, emergency general surgery, surgical oncology, colorectal surgery, and bariatrics/advanced laparoscopic surgery. First year residents serve as the chief of the burn service where they do all of the operative cases and learn floor management of a busy service supported by advance practice providers. Additional first year rotations include trauma surgery, vascular surgery, pediatric surgery, day ICU, nightfloat floor and later in the year nightfloat ICU.
Second year continues in a similar fashion with rotations on the core surgery services described above and vascular surgery. Additional rotations broaden their exposure with smaller subspecialty services featuring breast surgery and thoracic surgery. There is also the opportunity for elective rotations in select subspecialties to explore career interests. An exposure to transplant surgery is provided on elective general surgery service in addition to a dedicated rotation 3rd year.
This comprehensive surgical immersion dovetails into their critical care experience. Roughly 5-6 blocks are spent in the surgical intensive care unit between the first and second years to develop a strong foundation in the care of a critically ill patient. These ICU months are divided between day and nighfloat rotations. The night float experience, averaging 5 to 6 over months the two years, further solidifies their fundamentals in a tight knit resident team.
Third Year
Third-year surgical residents begin to learn leadership and organization skills on surgical services through a combination of hands-on experience, mentorship, and structured training. This is typically accomplished via various opportunities, including increased patient care management and operative responsibility and team coordination, and education and teaching of junior team members. They begin to function as the senior-most resident on certain services such as pediatric surgery and trauma to begin incorporating these necessary skills into their practice.
The night float system continues in the surgical consult role, the crucible in which every surgeon is molded, for 2-3 blocks, advancing resident decision-making skills and diverse case exposure. The remainder of the year is supplemented with continued experience on the core services, polishing critical thinking skills and more sophisticated operative techniques. Additional rotations include plastic surgery, a dedicated transplant rotation to learn multidisciplinary care of the transplant patient, possibly cardiac surgery and vascular surgery operative/flex role.
Fourth Year
Senior residents continue developing their leadership skills and clinical and operative management. They revisit prior services with newfound knowledge and operative skills, including breast and thoracic. Fourth years are also tasked with night float chief for two months of the year, making them the most senior surgical residents in the hospital. Residents further broaden their surgical exposure with community rotation at MaineHealth Maine Medical Center Biddeford to experience the breadth of the health system and better their understanding of patient care and coordination. As they progress, seniors transition to running the larger surgical services, such as surgical oncology and emergency general surgery, while continuing to fine tune their skills on the other core surgical services.
Fifth Year
The culmination of a resident's time in the program is the chief year. The final year of training is characterized by leadership, clinical excellence, educational engagement, administrative responsibilities, and preparation for the next phase of one’s surgical career. This is guided by serving as chief of one of the core surgical services most of the year. These core service tenures are extended over two months, bolstering resident-attending clinical relationships and allowing for augmented learning and polishing proficiencies. These core rotations include elective general surgery, emergency general surgery, surgical oncology, colorectal surgery, and bariatrics/advanced laparoscopic surgery.
A year-long “Chief Clinic”, supervised by core faculty and the program director, provides residents with enhanced autonomy and continuity of care. Chief residents learn office work up, pre op optimization, billing and the handling common postop complications as part of this experience. This clinic is an excellent source of Teaching Assistant (TA) cases where chief residents lead junior residents through an operation. Our chiefs have the opportunity to do significantly more than the minimum of 25 of these TA cases required by the Board of Surgery.
Chiefs supplement these educational experiences with individualized subspecialty rotations. At the year’s conclusion, they will be well-prepared for the next phase of their professional journey.
Didactics
Our program features an assortment of conferences centered around comprehensive surgical education. Educational time is split between two days, and this time is protected from clinical responsibilities to promote focus on learning.
Mondays are an hour-long session with rotating topics including Mock Oral Boards, Journal Club, Research Meeting, and Indications/Operative Prep. Thursdays are four hour-long conferences. The morning starts with a “This Week in Score” presentation based on the SCORE curriculum, led by a junior/senior resident team and supplemented by attending faculty. Morbidity and Mortality conference follows weekly from 8-9 AM where residents present cases and learn the process of quality improvement. Grand Rounds follows from 9-10 rotating between outside speakers, surgical faculty and some resident presentations. We conclude the morning with a weekly Department Chair meeting with the Vascular and General Surgery residents to discuss hospital and health system updates, new surgical literature, and other professional development topics.
There are educational conferences throughout the academic year tailored to level of training, including “Intern Bootcamp”, laparoscopy/endoscopy, patient-oriented discussions around goals of care and breaking bad news, among others. Outside of didactics, we work to incorporate opportunities to explore advanced surgical techniques and technology. We also have a quarterly “Melnick” session into the schedule where residents have team building activities (rock climbing, painting, escape room, etc) and a morning outside the hospital. Mentorship time is also incorporated twice yearly into protected time.
Certification
Successful completion of the five year program leads to recommendation for examination by the American Board of Surgery. View our ACGME data on Chief Residents Operative Experience.