The PGY-1 resident spends 3 months at St. Joseph’s Regional Medical Center (SJRMC) and 9 months at St. Francis Medical Center (SFMC). The 3 months at SJRMC are divided into 1-month intervals throughout the year. Two of the three months the PGY-1 resident is involved in covering patients on general surgery (GS) (including vascular and thoracic surgery patients), pediatric, and trauma/critical care services. The other month the PGY-1 resident is rotating on the orthopedic surgery service under the direction of Dr. Vincent McInerney, program director of Seton Hall University Orthopaedic Surgery Residency Program. During the orthopaedic rotation, the PGY-1 resident has no responsibilities to the other GS services.
 
The PGY-1 resident’s nine months at SFMC are spent as follows: 
•    6 months on the GS service, which includes vascular surgery;
•    2 months covering the subspecialties of  Neurosurgery, Ear, Nose, and Throat (ENT), Urology, and Gynecology; and
•    1 month on Cardiothoracic (CT) service under the direction of Dr. Glen Laub, chief of the division.

During this time, the PGY-1 resident does not cover GS and takes call as directed by the CT service.

For all the aforementioned services, the PGY-1 resident is responsible for the initial evaluation of all emergency, floor consults and elective admissions. The PGY-1 resident is under the direct supervision of the attending and/or the senior resident who discuss and formulate the initial treatment plan. The PGY-1 resident performs operations that are suited to his/her level under the direct supervision of a senior resident with the attending overseeing the operation. Both the senior resident and PGY-1 resident are required to participate in the pre- and post-operative care of these patients in order to guarantee continuity of care. Patients are seen in the outpatient, hospital-based clinic and the attending physicians’ private offices.
 
The PGY-1 resident is required to demonstrate proficiency in several minor surgical procedures. The residents are required to document these procedures in the form of a “pink book.” This book must be completed by the end of the PGY-2 year.      

Under the direction of the chief resident on the service, the PGY-1 prepares protocols for presentation at Tumor Board, Mortality and Morbidity, and other conferences of general and specialty surgical services.
 
In addition to developing diagnostic and management skills, the residents acquire basic surgical skills by performing as first assistant to the attending surgeon or senior surgical resident a variety of operative procedures.
 
The PGY-1 resident is exposed to the basic science laboratory during several rotations throughout the year. While on the subspecialty service, the resident is introduced to the basic science research methodology used in the Fox Chase Cancer Research laboratory on the SFMC campus. In addition, the PGY-1 resident is required to choose a research project by the end of his/her first year and a research mentor from among the full- and part-time faculty. This can be a basic science project or a clinical project. The PGY-1 mentor is responsible for the development and progress of the resident’s research project in conjunction with the program director. This project must result in either a publication in a peer-review journal and/or a presentation at a major national or international conference by PGY-4. 

PGY-2
The PGY-2 surgical resident rotates 9 months at SFMC and 3 months at SJRMC. While at SFMC, the resident rotates in the Intensive Care Unit (ICU) for 4 months and covers GS for 5 months. While covering GS, the resident is focused on consultations in the emergency room, floor consultations and operative cases. While at SJRMC, the PGY-2 resident focuses on pediatric surgery, trauma, ICU and GS.

The PGY-2 resident becomes familiar with the pre-operative planning and post-operative complications in ICU patients. At the conclusion of the ICU experience, the PGY-2 resident will become proficient in:
•    Fluid resuscitation;
•    The use of arterial lines;
•    Pulmonary artery catheters;
•    Endotracheal tubes;
•    Chest tubes;
•    Central nervous system monitoring devices;
•    Tracheostomy; and
•    Adept in the management of patients with imminent airway obstruction and respiratory failure.

They will participate as a surgical member of the Code Team in the resuscitation of patients throughout the hospital and in the ICU.

As part of the General Surgical Service, the PGY-2 resident assumes increasing responsibilities in the care of same-day surgical patients and for emergency department evaluations and floor consults for surgical patients.

The PGY-2 resident continues his/her research project under the mentorship of either a full- or part-time faculty member in conjunction with the program director. This may include either basic science research in the laboratory or a clinically based project requiring analysis of medical records and/or literature review.

The resident is to complete the procedures in the “pink book” by the end of the PGY-2 year.

PGY-3
Third-year surgical residents spend 3 months at SJRMC, continuing their experience in pediatric surgery, trauma, ICU and GS. The PGY-3 resident spends 8 months at SFMC, and 1 month at St. Barnabas Medical Center. The PGY-3 resident rotates through the Pathology Department for 2 weeks and the Anesthesiology Department for 2 weeks during the 8 months at SFMC. On pathology, the resident participates in the pathologic assessment of surgical specimens and autopsies. While on anesthesia, the resident assists with the management of general anesthesia in the operating room and gains knowledge in the various methods of intubation, induction, and the maintenance of surgical patients under general anesthesia. The resident must become familiar with the pharmacology of various regional and general anesthetics and the possible complications that can result from their use. They should become aware of the pathophysiology of malignant hyperthermia and the management of the difficult airway in the operating room.

During general surgical assignments in the third year at SFMC, the resident assumes increasing responsibility for the evaluation and treatment of elective and emergency admissions and is expected to perform more complex surgical procedures, including gastrectomy, mastectomy, laparoscopy and bowel resection.

During the pediatric experience at SJRMC, the PGY-3 resident is expected to further his/her knowledge of the pathophysiology of surgical diseases of the neonate, infant and child. During the trauma experience at SJRMC, the PGY-3 resident is expected to learn the principles of management of blunt and penetrating trauma and to apply the principles of evaluation and resuscitation as outlined in the Advanced Trauma Life Support course to which they are certified. At the PGY-3 level, the resident will take a more prominent roll in the decision-making process involved in the initial evaluation and treatment of the trauma patient.
 The PGY-3 resident during the rotation at St. Barnabas Medical Center’s Transplant and Burn facility will acquire knowledge of the evaluation and management of both transplantation and burn patients.

PGY-4
The fourth-year resident spends 9 months at SFMC and 3 months at SJRMC. During this time, the resident becomes involved in more complex general surgical cases, particularly in the fields of vascular and oncologic surgery. The resident shares responsibility for the emergency management of the multiple trauma patients in the emergency room and the operating room with the chief residents. The resident also becomes more involved in the teaching of junior residents and rotating medical students. Each fourth-year resident assists the chief residents in running the various services and making assignments. The PGY-4 resident is in the final phase of his/her research project, preparing a manuscript for submission and/or presentation.

PGY-5
Chief residents spend 9 months at SFMC and 3 months at SJRMC, continuing to increase their experience in complex surgical problems and endoscopy, including colonoscopy, upper endoscopy, flexible sigmoidoscopy and bronchoscopy. The chief resident is responsible for the daily management of the GS services and is increasingly involved in the teaching of junior residents and rotating medical students. Responsibilities include organizing the on-call and vacation schedule for the year. In addition, the chief resident is responsible for the daily operations of the residents and is expected to maintain the orderly function of the service. 

The chief resident spends time addressing special areas of interest in order to prepare for further subspecialty training. This must be approved by the program director in advance. The chief resident is also required to attend a national meeting.

Chief residents participate in the mock boards in preparation for the certification exam and attend a nationally recognized board preparation course.