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Resident Rotations:

Our training philosophy emphasizes total patient care including outpatient pre and postoperative care, pre-operative decision making, intra-operative technique and operative strategy, and postoperative critical care. Residents on each rotation participate in all these aspects of patient care, including all ICU care, with increasing responsibility commensurate with their experience and PGY level. Clinics are part of most all rotations.

Trauma Service at ULH:

The are two acute care surgical services at ULH and typically the team consists of PGY-5, 3,2, and 1 general surgery residents and PGY-1 rotators from other specialties. The entire team is in house during their particular shift and average census is 40 patients per team with about 15 in the ICU. All acute care patients including emergency general surgery, blunt and penetrating trauma, and burns are admitted to this service. The team also provides critical care consultation to other services in the ICU. Faculty include Drs. Harbrecht, Smith, Franklin, Benns, Miller, Nash, and Bozeman with additional faculty providing night and weekend coverage. Four nurse practitioners assist the two teams with patient care and documentation. The operative experience includes a wide variety of urgent cases in these areas and there are two trauma clinics per week for ambulatory follow-up. There are also intensivists (PGY-2) and floor day floats to assist the post call team and insure continuity of care.

Elective Surgical Service at ULH:

This team is comprised of a PGY-5, 3, and 2 including rotators from other specialties. Cases include a variety of open and minimally invasive procedures including intra-abdominal procedures, hernia repairs, and endocrine procedures with an average inpatient census of 15 patients. There is one clinic day per week for ambulatory care and continuity of patient care. The team also takes night call twice per week to relieve the trauma teams and comply with the ACGME duty hours requirements. The residents in the lab also assist twice per month and the critical care fellows also take call as well.

General and Thoracic Surgery Services at the VAMC:

There are two teams at the VA. Each team is comprised of a PGY-5, 3 or 2, and two PGY-1s and cases included a wide variety of surgery for benign and malignant diseases including vascular and endoscopy. Faculty include Dr. Gaar, Chief of Surgery, and Drs. Wrightson, Cheadle, Franklin, Kasdan, Larson, McCafferty and one nurse practitioner. There are several clinics at the VA including general surgery, vascular, and colorectal, and residents see all patients under attending supervision.

General Surgery at Norton Hospital:

This team consists of a PGY-4, 3, 2, and 1 as is responsible for all general surgery patients which averages about 50 patients. Drs. Vitale, and Bahr have busy practices based at Norton and residents perform a wide variety of procedures including pancreatic, hepato-biliary, basic and complex minimally invasive cases, complex re-operative cases, and endoscopy. Other faculty include Drs. Cheadle, Flynn, Kehdy and Larson, and one nurse practitioner.

General Surgery at Jewish Hospital:

This 3 person team consist of a PGY-4, 3 or 2, and a 1. Several busy general surgeons including our acute care surgical faculty have a busy broad based general surgery practice which includes many emergency cases. Dr. Sutton has special expertise in minimal access surgery and a special interest in mentoring both residents and medical students. The team also participates in patient care of a busy private practice group on the clinical teaching faculty and the average total inpatient census is 30 patients.

Transplant Surgery at Jewish Hospital:

This team consists of a PGY 4 or 3, and a 1. Residents participate in all aspects of kidney, pancreas, and liver transplantation including operations, peri-operative critical care and immune suppression regimens under the supervisions of Drs. Marvin, Eng, Hughes, Davis and Jones. Residents also attend 3 weekly transplant clinics and closely interact with two transplant coordinators with an average inpatient census of 10.

Vascular Surgery Service at Jewish Hospital:

One resident (PGY-2, 3, or 4) rotates on this private vascular service under the direction of Drs. Self, Alankar, and Lipski. The resident performs or assists on a variety of open and endovascular cases with an average inpatient census of 20.

Colorectal Service at ULH, Norton, and Jewish Hospitals:

This service consist of the colorectal fellow and a PGY-4 or 5, and a PGY-1, under the supervision of Drs. Galandiuk, Jordan, Deveaux, and Farmer. Patients are independently managed by either the general surgery resident or colorectal fellow. General surgery residents participate in both routine and complex colorectal operations, faculty and resident clinics, and the colorectal conference. This service emphasizes one-on-one teaching to the general surgery resident in the private office of these faculty members. The average in patient census is 15, and the general surgery resident sees about 50 outpatients per week, which includes office procedures.

Surgical Oncology Service at ULH, Norton, and Jewish Hospitals:

This service consists of the surgical oncology fellow, and three general surgery residents (PGY-4, 3, and 1) under the supervision of Drs. McMasters, Martin, Scoggins, Flynn, Quillo, Phillips and Ajkay. The fellow and general surgery residents manage their own patients independently, and there is emphasis on faculty resident teaching in the private office. Residents perform a wide variety of oncologic surgery including visceral resections, hepatectomy, pancreaticoduodenectomy, sarcoma resections, wide local excision of melanoma, and breast cases including sentinel node biopsy, partial/total mastectomy and axillary dissections. The average in patient census is 15. Residents also participate in tumor board, melanoma, conference, and breast and surgical oncology clinics in the ACB at ULH, seeing approximately 30 outpatients per week.

Vascular Service at ULH and Norton Hospitals:

This service consists of a PGY 5 or 4, and PGY 3 or 2 under the supervision of Dr. Dwivedi. Residents perform a variety of both open and endovascular cases including many vascular emergencies, and the average inpatient census is 25. They also participate in vascular and diabetic foot clinic in the ACB at ULH, seeing about 15 patients per week, and present cases at the weekly vascular conference.

Pediatric Surgical Service at Norton Children's Hospital:

This service consists of the pediatric surgery fellow, and four general surgery residents (PGY-4, 3 or 2, and two 1s) under the supervision of Drs. Fallat, Bond, Downard, Foley, Murrell and Wisenhauer. Norton Children's Hospital is one of the nations largest and the residents will perform a variety of cases on pediatric patients from newborns to teens. These include index cases, neonatal procedures, complex abdominal procedures, and the more routine hernias and appendectomies. The inpatient census is about 60 including the NCIU and ICU, and these unit patients are managed in conjunction with the pediatric intensivists and neonatologists.

Rural General Surgery Rotations

Residents at the PGY-2 to 4 levels may choose electives at either Madisonville or Owensboro, during which time they will work with several general surgeons both in the hospital and their offices. Owensboro is located about 106 miles and Madisonville 130 miles west of Louisville. The resident typically performs about 75 general surgical cases per month and gains knowledge of typical rural practices in these areas.

Endsocopy:

One resident participates on this rotation at VA and Norton Hospitals. The primary focus is routine upper and lower endoscopy, although there are substantial interventional cases. The goal of the rotation is to accumulate the required endoscopic cases for the ABS and to gain privileges for practice to perform EGD, PEG, Colonoscopy and polypectomy. Our residents generally exceed the required minimums of these cases and often perform these cases on their own patients at VA and ULH to keep up their skills. This resident also carries the organ harvest pager to assist the transplant team.