The five-year Nuvance Health General Surgery Residency Program is structured to ensure residents participate actively in a wide range of cases from all surgical specialties. Each rotation is structured as blocks, fully immersing trainees in the surgical specialties to which they are assigned. Training sites include Vassar Brothers Medical Center (VBMC), Northern Dutchess Hospital (NDH) and New York-Presbyterian/Columbia University Medical Center. Residents also can participate with elective rotations. An example of one resident’s training in this program is shown below. This is just an example and may be adjusted by the program director to ensure adequate experience, case log numbers and ACGME compliance.

All surgical services are supported by an outstanding team of surgical PAs. Ancillary services are robust and include (but are not limited to)

• -IV Team
• – Phlebotomy team
• – Code team, stroke team, trauma team, Resource Nurse support
• – 24/7 patient transport serviceS

As a newer residency program, our curriculum and residency design has been optimized based on resident feedback to provide the highest educational value, while de-emphasizing traditional “service” requirements.

Rotation colors are based on teams and coverage of service lines.

Core rotations encompass the majority of our resident teams. Residents also have dedicated rotations in the ICU, Breast Surgery, Head/Neck Surgery, Endoscopy, Pediatric Surgery (NY Presbyterian), Liver Transplant (NY Presbyterian), Bariatric Surgery (Northern Dutchess Hospital), and separate dedicated thoracic and vascular rotations.

Journal Club

As a first step in learning how to effectively practice evidence-based medicine, interns and residents participate in Journal Club to appraise surgical data published in the medical literature.

Multidisciplinary Tumor Disease Team Conference

The purpose of the Multidisciplinary Disease Team (MDT) “Tumor Board” is to coordinate care with multidisciplinary physicians and ancillary staff.  Cancer conferences improve the care of cancer patients by contributing to the patient management process and outcomes, and by providing education to physicians in attendance.   At the moment all MDT meetings are virtual and this can help facilitate attendance by residents.  Nuvance currently has unique MDT meetings for general tumors, rectal cancer, breast cancer, thoracic malignancies, urologic cancer, and head/neck cancers.

Surgical Oncology Case Conference

Residents, medical students, and PAs assigned to the Green Team (Surgical Oncology) attend weekly teaching meetings at 7am each Friday with faculty.  The purpose of the meeting is to review cases for the coming week, highlighting unique educational and instructional aspects of cancer care.

Trauma Conference

Residents are welcome to attend periodic multi-institutional virtual trauma conferences.  Many trauma centers from western hemisphere participate.

Boot Camp

As a new resident, you will participate in an intern boot camp during your first week here. This will help you adjust to residency life and provide you with an overview of programs, topics and required information.  Basic skill labs are administered and ample opportunity is given to become more comfortable with transitioning to resident life.

In-Service Training Exam

ABSITE In-Training Exam Residents’ medical knowledge and clinical reasoning will be benchmarked for measuring longitudinal growth through the results of the annual American Board of Surgery In-Training Exam. All general surgery residents will complete the exam. Results will be reviewed with the program director to inform discussions and individualization of curriculum and clinical training (e.g., reading material, board prep and electives).

Mock Oral Exam Prep

Beginning in the PGY-3 year, mock oral exams are administered to help prepare the resident for the American Board of Surgery Certifying Exam.  Periodic sessions are administered by faculty from other residency programs.  This helps generate a sense of unfamiliarity with the examiner in order to make the environment more consistent with the actual examination.

Academic Half Day

Most didactic experience occurs on Thursday mornings, starting with M&M at 7am.   Residents enjoy protected time to focus on the educational aspects of residency. Mandatory conferences are held regularly in the Nuvance Health General Surgery Residency Program. The following lecture schedule applies to the program, and attendance by residents and faculty is required.  The Surgical PA Service provides floor coverage during protected time.

All lectures are designed to provide residents with a broad range of knowledge on the ACGME competencies and the SCORE Curriculum concepts. 

SCORE Conference

The SCORE Curriculum Outline for General Surgery is a list of topics to be covered in a five-year general surgery residency program. The outline is updated annually to remain contemporary and reflect feedback from SCORE member organizations and specialty surgical societies.

Topics are listed for all six competencies of the Accreditation Council for Graduate Medical Education (ACGME): patient care; medical knowledge; professionalism; interpersonal and communication skills; practice-based learning and improvement; and systems-based practice. The patient care topics cover 27 organ system-based categories, with each category separated into Diseases/Conditions and Operations/ Procedures.

All lectures are designed to provide residents with a broad range of knowledge on the ACGME competencies and the SCORE Curriculum concepts.

M&M

Weekly, 7 am Thursdays

SCORE

Thursdays

Program Director’s Conference

Informal case discussions and board review scenarios, Thursdays

Multidisciplinary Tumor Conference

Breast – Tuesdays 7:30 am

Thoracic – Tuesdays Noon

Rectal/Upper GI – Wednesdays 7:30 am

Head/Neck – Thursdays 7:45 am

Service Rounds

Daily each morning before first cut with the supervising faculty, chief resident, charge or OR nurse, and other pertinent members of the patient care team.

Grand Rounds

Monthly topics cover a wide range of medical and surgical subjects.

Schwartz Rounds

Quarterly, system-wide conference dedicated to wellness. Recent topics included “Nurturing Resilience in Ourselves and Others” and “Injustice and Bias in Healthcare.”

Residents who are well make excellent physicians. The importance of wellness is emphasized throughout the residency program.

Some examples of things we’ve done

• Strict adherence to 80 hour work-week (plus NYS duty hour restrictions)
• Annual welcome party for incoming residents
• Peloton exercise bike located in the Surgical Resident Call Room
• Newly refurbished Call Room space
• Annual fitness and nutrition workshop
• Collegial and mutually respectful atmosphere
• System-wide Schwartz Rounds
• Access to mental health and employee assistance program
• Anonymous program feedback options
• Faculty “open door” policy
• Annual “Doctor Day” – residents are mandated to take one day per year off in order to attend visits to their primary care physician, etc.
• Residency-sponsored events such as
  • Hiking and Axe throwing event
  • Apple picking

As a newer residency program, feedback from residents has been critical to our success so far.  Our residents meet with our Faculty and Program Director frequently to review our program and make changes as appropriate.  To date, several important changes have been established based on resident feedback to further enhance the educational environment at Vassar Brothers Medical Center.

Each resident pairs with a faculty mentor who offers encouragement and support. Mentors assist residents in background research, feasibility, Institutional Review Board (IRB) approval, study design, implementation and analysis, and quality improvement projects.

General surgery residents are encouraged to present all research within the department, locally, regionally or nationally, including during the annual Nuvance Health Program Resident Research Day, when residents in all specialties may present posters and oral presentations showcasing their work.

Clinical Trials

• Breast Cancer Clinical Trials
• Colorectal Cancer Clinical Trials
• Melanoma Clinical Trials
• Lung Cancer Clinical Trials
• Genetic Cancer Clinical Trials
• Gynecology/Oncology Cancer Trials

Residents have access to a quality assurance officer who assists in the development and implementation of all quality improvement projects. In addition to each resident’s project mentor, the quality assurance officer serves as an excellent resource for residents to use when working on quality improvement projects and implementation or analysis.

Residents are also supported by the quality assurance team committee at each training location. This experience provides residents with the ability to see quality assurance and improvement issues and solutions from a hospital perspective.

Residents are also provided with access to NSQIP, a surgical de-identified registry of all procedural cases that compares data between teaching hospitals across the nation. This serves as another great resource for residents to find data and conduct robust clinical research. This data is stored on a cloud-based library. In addition to NSQIP, residents have access to registries such as VQI and Society for Thoracic Surgery (STS), and the National Cancer Database (NCDB).

Our residents have an incredible operative experience. Our institutional case volume and breadth can easily support an expansion of our residency program, but our plan is to keep the residency program intentionally small to enrich the educational experience and exposure to a high volume of routine and complex surgical patients.

Our PGY-1 residents have averaged >200 cases (not including 2nd assist) during their first year of training.

PGY-4 Current case volume, through 10/1/2022

Each resident is experienced in simulation at Nuvance Health.

Laparoscopy simulators are available in resident space at Vassar Brothers Medical Center.  The DaVinci Robotic Skills Simulator is available to residents for extra training including off-hour/weekend access so that residents may practice while on-call.  The Robotic Curriculum ensures that each resident develop proficiency in surgical robotics early in residency training.  Once basic and bedside proficiency is gained, residents begin work on our dual-console robotic platform.  Our goal is to assure that each resident is ready for a robotic practice upon graduation.

In addition to robotic and laparoscopic simulation experiences, the Surgical Residency Program at Vassar Brothers has a formal endoscopy curriculum and periodic workshops.  Some recent workshops have included:

• Vascular anastomosis workshop
• Skin closure workshop
• Airway procedures
• Robotic day
• Intra-operative fluorescence workshop
• Surgical Stapling workshop

In addition to simulation options at Vassar Brothers Medical Center, The Harold A. Spratt Center for Simulation and Clinical Learning is a new state-of-the-art facility located at Danbury Hospital.  VBMC residents have access to this center.

Highlights of the Center

The Harold A. Spratt Center produces cutting-edge health care simulation by offering three primary simulation labs replicating an intensive care room; an inpatient general medical surgical room, including a full bathroom; and a labor and delivery/neonatal intensive care room. Each of these labs provides:

• Flexibility to replicate alternative clinical environments, such as outpatient exam rooms
• Control rooms isolated from the lab space to allow remote control of simulators and audio/ visual equipment
• One-way glass to allow learners a sense of independence while maintaining direct supervision by faculty
• Networking to support the integration of the highest tech simulation equipment available
• Functioning hospital gas panels with oxygen, air and suction
• A monitor to display vital signs and data pertinent to a simulation scenario

Features of the Center

The Center also features:

• A medication room that can be integrated into simulations in the three primary labs
• A reception area designed and configured to double as a fourth simulation lab
• High-fidelity manikins that simulate human physiology and pathology
• Two large debriefing rooms for instruction and discussions
• Cutting-edge  audio/visual  capability  so scenarios can be recorded and played back for analysis while debriefing and data can be captured for research or assessment
• A standardized patient program that uses live people trained to act through clinical scenarios
• Educational and technical support from a specialized simulation team to ensure well-executed and effective utilization of simulation modalities

Teaching

Nuvance Health – Vassar Brothers Medical Center (VBMC) surgical residents have important teaching roles for medical students. We are a primary teaching site for third- and fourth-year students at the Touro College of Medicine, and we routinely welcome visiting medical students to our services.

In addition to teaching medical students, PGY1 residents from the VBMC Transitional Year Residency (Blue, Green) and the Emergency Medicine Residency (Trauma) rotate through the Department of Surgery.

How to Apply

We accept all applications through the ERAS only and participate annually in the NRMP Match Program.

Interview Requirements

The following items are required for interview consideration.

• Personal statement
• Three (3) letters of recommendation
• USMLE Step 1 CK score
• USMLE Step 2 CS score
• USMLE Step 2 CK score
• MSPE (Dean’s) letter

Incomplete applications will not be considered.  Direct requests (emails) to program staff and faculty to review applications outside of the ERAS application process will not be considered.  We do not have a minimum USMLE Step I score requirement.

Interviews

For the 2022/2023 academic year, interviews will be virtual.  Once interviews are released, applicants will have 48 hours to accept or decline the interview date.

Second Look Date

After interviewing, applicants interested in our residency program are encouraged to come for a second look date in February.  The second look is optional, and the purpose is solely to provide applicants with as much information as possible about our training program, and to spend some time in New York’s beautiful Hudson Valley. The second look date follow our rank list completion, and as such the decision to attend the second look will not influence the rank list position.  The second look day will start with the Department of Surgery’s weekly M&M conference and didactics. Candidates will have opportunities to spend time with our house staff.

What are the rules around vacation?

Residents have four one-week blocks of vacation a year.