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The goal of our General Surgery residency program is to educate excellent surgeons with the capability of choosing from a variety of surgical careers. While many elect to enter the practice of general surgery on completion of their training, the majority of graduates presently elect to pursue fellowships in vascular surgery, surgical critical care, trauma surgery, surgical oncology, colorectal surgery, pediatric surgery, GI surgery, minimally invasive surgery, cardiothoracic surgery and plastic surgery. Graduates have established academic careers in various institutions across the country and have entered private practice opportunities.
Experience is provided in the broad range of general surgery as defined by the American Board of Surgery as well as in all other surgical subspecialties. The educational program is supervised by the Chairman of the Department of Surgery and the Director of Surgical Education. Education is provided by experienced surgeons in private practice and a full-time surgical faculty. The program presently trains four chief residents each year. In addition to receiving a broad and intense clinical experience, residents are expected to carry out clinical investigation; historically they have presented these results both at regional and national meetings.
Appointments are made at the PGY-1 level only through the National Resident Matching Program. Of the seven PGY-1 appointments, four are for candidates wishing to complete a five year general surgical program one is a designated preliminary position for urology, one is a designated preliminary position for vascular surgery, and one is a non-designated position. The program is non pyramidal with annual reappointment based on demonstrated competency and professional maturation as judged by the staff.
The residency has recently undergone a restructuring to deemphasize large services and to move to a system of smaller, discrete experiences with a closer attending-resident relationship. In addition to the resident components of these services, there are 24 NPs and PAs who work on the services shoulder to shoulder with the residents. The residency is structured with the following major services:
Acute Care Surgery
The acute care surgery service offers residents experience with acute care and emergency general surgery. These are patients entering the hospital through the emergency room or through interhospital transfer with emergent general surgery problems. The complexity of these problems ranges from straightforward appendicitis, to multiorgan complex general surgery procedures. There are two residents on the service coupled with a single attending who rotates on a weekly basis
Elective General Surgery
The elective general surgery service is typically a two resident service that cares for patients with elective general surgery problems ranging from inguinal hernias to Upper gastrointestinal reflux. Oncology is usually not part of this service. There are two core attendings, and a number of other subspecialty attendings who do occasional elective general surgery cases.
Colorectal Typically another two resident Senior-Junior team Colorectal Surgery provides residents with a focused experience treating all types of colorectal diseases including from colorectal cancer, and IBD, too hemorrhoids. There are three attendings on this service.
This service provides a focused endoscopy experience that follows the American Board of Surgery flexible endoscopy curriculum. Many PGY 1s will leave the service with their upper endoscopy competency completed. Again, usually this is a two resident Senior-Junior pairing and in addition to endoscopy, this service provides an experience in advanced laparoscopy including ventral hernias, Nissens, inguinal hernias and morbid obesity surgery, all laparoscopic, all the time.
Surgical Critical Care
The intensive care unit at MMC is a semi-closed unit and critically ill surgical patients are typically managed by the surgical critical care team. Interns in their second half of the year and second-year residents throughout the year join a team of Emergency Medicine and Anesthesiology residents on White Surgery. Residents learn ventilator management, bedside procedures ranging from central venous access to bronchoscopy, management of patients with ruptured aortic aneurysms, major trauma, sepsis and more.
The HPB service is comprised of resident senior and a junior, or sometimes a senior and an APP. This is an opportunity for a one on one experience with a senior oncology surgeon who’s practice is mostly upper foregut oncology. This service always has a chief resident or late PGY 4 reflecting the case mix of liver and pancreatic resections.
The endocrine service is another one on one experience with a senior endocrine oncology surgeon. The resident will learn both the inpatient and outpatient management of endocrine disease.
Skin, Soft tissue and Breast
The SST service is the only service that takes place mostly outside of the inpatient walls of Maine Medical Center. There are two attendings on this service whose offices are at the outpatient Scarborough campus where the multi Breast Center is located. This is generally a single resident service, usually also paired with an NP or PA.
Trauma Surgery Residents on the trauma service are a mixed team of Surgery and Emergency Department interns led by a third- or fourth-year Surgery chief. The service is busy, caring for the large majority of the trauma patients admitted to this level I trauma center. There are also regular opportunities for learning bedside procedures such as chest tube placement and wound incision and drainage.
Vascular and Transplant Surgery
This is a 3 person service with a chief, a second or third year resident and an intern. This is a busy vascular service with a variety of open and endovascular exposure. When a third year resident is on the team, they assume primary responsibility (including operative responsibility) for all transplant patients, attending interdisciplinary rounds on Mondays, Wednesday and Fridays as well as transplant clinic and conferences.
This surgical service is managed by the PGY-3 surgical resident and a PGY 1 at times. They perform more than 1,500 general pediatric and thoracic cases per year, ranging from neonates with congenital anomalies such as esophageal atresia, imperforate anus, biliary atresia, and gastroschisis, pediatric solid tumors of the chest and abdomen, and pediatric general surgical diseases including pyloric stenosis, intussusception, gastroesophageal reflux, hernias, IBD, cryptorchidism, Hirschsprung's, and appendicitis. One mid-level pediatrics resident also rotates on this service, as well as third and fourth year medical students, and the curriculum is structured to provide education regarding the unique features of caring for children with respect to preoperative assessment and resuscitation, surgical techniques, and postoperative recovery.
Many medical students and residents are interested working or doing part of surgical training in a developing country. There is a long tradition of supporting and providing those experiences for residents at Maine Medical Center, one that we hope to keep and to build upon. Currently residents are able to take some of their elective time to work overseas with different surgeons from Maine Medical Center in Haiti, Africa, and other places. This has been a relatively informal, resident driven, experience thus far but we are in the planning stages of making it a more formal option in the General Surgery training program in Portland. While not yet finalized, we are working towards developing a long-term program that will provide continuity for residents here, abroad, and the communities we are working with. If you are interested in international surgery please contact Dr. Monica Langer, Assistant Program Director, to discuss your experiences and interests. We welcome any ideas and Dr. Langer is happy to answer questions you might have.
On my residency interview day, it was clear to me that the faculty in the department of surgery had chosen to work at a place where the priority was patient care and resident education. Many of my mentors at MMC came from academic appointments at large university programs. Maine Medical Center offered them an excellent group of colleagues that pushed them to stay at the forefront of surgical care without the intense pressure of an academic career. They brought with them a commitment to intellectual rigor that trickled down through the residency program.
As a resident, I was exposed to the entire breadth of general surgery from advanced laparoscopy to critical care to neonatal cases. From the first day of residency, I played vital role in all aspects of patient care from the operating table to the bedside. I chose to pursue a fellowship based on the experience I had as the sole resident on the pediatric surgery rotation. I had individual attention from the staff without having to compete with other residents or fellows for cases.
My wife and I started our family in Portland. We cannot think of a better place to have spent the busy residency years. The ocean in our backyard, the change of seasons, and the local restaurants were perfect distractions from the stresses of surgical training. I will always be grateful for the rare opportunity to be an alumnus of the Maine Medical Center surgical residency program.
Adam Gorra, M.D.
Pediatric Surgery Fellow, Omaha Nebraska
MMC Resident 2004-2009
Portland and the Maine General Hospital had a distinguished surgical history long before the initiation of a formal surgical residency. After World War II, hospitals were encouraged to provide opportunities for specialty training to meet the growing medical needs in this country. Dr. Carl Robinson, Dr. Isaac Webber, and others at the Maine General organized a Residency in Surgery, which received its final approval from the American College of Surgeons in 1947. Originally, the Residency was three years in duration in addition to surgical specialties in order to prepare the graduate for rural practice. The resident case experience came from clinics and emergency cases, as well as observing the practices of experienced surgeons. Medicare legislation in 1965 made this system inadequate, and thus private patients were gradually integrated into the teaching program under the guidance of Drs. Emerson Drake and Richard Britton.
By the 1970's, the Maine General had been superseded by the Maine Medical Center, surgical volume and sophistication were rapidly growing, affiliations with the Mercy Hospital and Togus Veterans Hospital were developing, and the Residency Program was beginning to attract applicants from beyond the local area. The program included numerous rotations in the surgical subspecialties until the 1980's, when an emphasis on the "principal components" of general surgery was mandated, and it still retains much of the flavor of preparing graduates to handle "whatever comes down the pike." Many graduates in this era chose to continue with fellowship training, which helped lead to a national reputation for the MMC program.
Under its current leadership in the 1990's, the Surgical Residency has continued to meet the increasingly standardized requirements of the Residency Review Committee. The core of the MMC's Surgical Residency is commitment to taking excellent care of sick patients. During the five years, residents work with large numbers of patients with a wide variety of both surgical and medical problems. Patients come from the private practices of the teaching staff, from the surgical clinics and from the emergency services. In addition to a large operative experience, dedicated time is provided for residents in the offices of faculty surgeons and in the surgical clinics. This important outpatient experience involves the resident in the crucial evaluation and decision process for elective surgery and in the follow up after surgery. The progressive responsibility of hands on patient care is supplemented with structured didactic conferences based on a planned curriculum of both instruction and evaluation. Residents are also encouraged to work with the faculty in research efforts and publications during their training. The goal of this effort is to provide well trained, well educated surgeons dedicated to the excellent care of their patients and capable of proceeding to independent practice or to further specialty fellowship training depending on their interests.
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