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We have a new PD, and with him came new schedules. We have two elective general surgery services, an acute care surgery service, a trauma service, and a critical care service. There are also other specialty services that PGY2-4 rotate on intermittently. The day starts at 6AM at signout; it occurs in the same conference room for everyone; you pre-round on your patients after that. You usually run the list as a resident team before first case between 7-7:30 and round independently with attendings between cases or after clinic. The trauma and critical care services have more formal rounds with attendings. The day ends at evening signout at 5PM for everyone. We have a night float system, so the night team takes over from 5PM-6AM. An intern, second year and fourth year make up the call team Sunday-Thursday nights. Residents from the other services are pulled to take call on the weekends, so if you're not on night float, you'll likely be taking call on the weekend, but you usually get one weekend free of call a month.
The faculty in general are great. They are made up of academic and non-academic surgeons, and you get to see the different methods of both groups. We have two conferences days a week, M&M on Wednesday and grand rounds on Friday. We are assigned a chapter out of a text book by our PD every week (this year we are using Sabiston, but I hear we will be switching texts every year), and have a "basic science conference" after grand rounds every Friday, which is basically just a pimp session with the PD on the chapter assigned for that week. Then, after M&M the following Wednesday, we have the "Evidence Based Medicine" conference, which is basically a quiz with ABSITE-like questions written by the PD on the chapter from the previous week.
The didactic sessions are very much ABSITE-oriented. This program has had trouble with low ABSITE scores in the past and there is a conscious effort to improve the scores, however, I have a somewhat philosophical objection to trying to teach the test. With the ABSITE a few weeks away, we shall see how well it works.
The camaraderie is improving. There was a problem in the past with several residents who were difficult to work with, but that is getting better. In general everyone gets along, but we're not all best friends. The older/married residents tend to do their own thing more than the younger/single residents.
The residents and attendings get along. Our attendings are some of the least malignant people I could imagine being surgeons. Our new PD is probably the most malignant attending, but he's definitely an outlier.
The hospital is a nice facility. There are often issues with administration, who aren't known for their common sense, but in general it's a nice hospital to work in. Despite what others may say, the food is actually pretty good for cafeteria food...I've had A LOT worse.
I definitely have a life outside of work. Not so much on night float, but even then I get the weekends off. I usually work 60-70 hours a week; that's per week, not average. I have not worked greater than 80 hours in one week this academic year.
The main thing that stands out are the attendings and the opportunity to operate early. I think the early operative experience is actually better now that we have the Acute Care Surgery service.
The biggest drawback I've noticed lately is that our PD gives the impression that he plays favorites. One of the main problems we had with our old program director was some people got away with a lot of things they shouldn't have, and I was hopeful that the new PD would change that, but unfortunately the same people are still doing the same things. Some things have gotten better, other things haven't.
I definitely think I'll be prepared once I finish. A lot of interesting pathology and operative exposure.
I would definitely consider this program if I had to re-apply. However, this isn't the same program it was when I arrived; some good, some bad.
Most graduates end up going into private practice, however, we've had quite a few do fellowships recently. A majority of those seeking fellowships have done vascular.
I typically arrive at the hospital around 5:30am. We finish rounds before 7am, and "run the list" with the chief of the service. Daily goals are set for the day, and usually left for the intern to complete while the more senior residents on the team go to the OR. Scutwork is minimal, but social issues, disposition, discharges, etc, cannot be avoided. I usually leave the hospital around 6pm after checking out to the on-call intern. The 80hr work week is strictly enforced and is rarely a problem.
The hospital overall is a great place to work. The staff are friendly, and the enviornment is clean. Half of the hospital is brand-new. We have learning conference on Wednesday mornings and M and M on Friday mornings. Teaching in the OR is variable depending on the attending, but overall is pretty good. I am not affraid to ask questions. The conferences are good, but we need to focuse more on a basic text such as Sabiston or Schwartz. This will probably occur with the addition of our new program director.
Camaraderie among fellow residents is great. We all get along for the most part, and are willing to help each other when needed. I can ask my cheifs for help at any time. Attending-resident relationships are also great. We work with some of the nicest attendings possible. The percentage of foreign medical graduates is small. There are about 4 out of 30. A life outside of work is very possible. Most of my co-residents have children and families. They seem to be happy, and have enough time. With that being said, surgery still demands more hours than most other programs. If you are really worried about how much free time you will have, then you should probably pick another speciality.
The most outstanding points of this program include: great work environment, and early operative experience. The drawbacks include several months spent on the trauma service (different PGY years) where you are not allowed to take vacation. I would certainly choose this program again, and I feel that I will be well prepared once finished. Graduates of this program can do almost anything including rural general surgery or very competitive fellowships. I highly recommend this program.
I begin my day at 5:30 or 6:00 depending on the rotation and the size of our census. Morning report occurs weekdays at 6 AM and weekends at 7 AM (so I can go in a little later on the weekends). As an intern you rotate through general and specialty surgery services. You also do trauma and 2 months of critical care. One of those months is a night rotation (13-14 hour shifts 5 days a week). I have never worked more than 80 hours per week when averaged over the month. Critical care, trauma, and one of the general surgery services tend to have longer hours. There were many weeks that I only worked 65 hours per week. The call is about 4-5 times per month. You go home on time postcall. The workload averages out to be just right. It varies from service to service but but is never unbearable. As an intern you of course are responsible for the floor work but there is plenty of opportunity to go to the OR. As an intern I had close to 200 surgeries and procedures (this counts chest tubes, lines, and OR). Depending on the attending you can be very active in the OR. I have done a couple of lap choles and hernias by myself. The trauma experience is well rounded. Mostly blunt trauma but we have penetrating trauma 1-2 times per week on average. The amount of trauma is sufficient but not overwhelming. As a surgery resident you do run the trauma (not run by the ER attendings).
The faculty (for the most part) are great. They care about the residents. Several of them go out of their way to teach on a regular basis. On one of the general surgery services, there are small group lectures/discussions at least twice per week. There is teaching in the clinic and in the OR with most attendings. This is all of course in addition to the weekly lectures. We have conferences/didactics on Wednesday mornings for 2-4 hours. These are lead by the attendings. Some are pure lectures and others are more interactive. The residents lead journal club and trauma conference once per month. M&M are on Friday morning for an hour. They are almost too benign. There has been a change throughout the year where the attending are asking more questions of the speaker and other residents to create a better learning environment. It could still use some improvement. We have a renovated sim lab with some cool stuff in it like a lap mentor, endoscopy trainer, mediman, light boxes for laparoscopic training. The bad thing is that we do not get open access to it at this point. Hopefully this will change so we can use it whenever we have free time.
On of the better things about the program is the relaxed environment. It is friendly. Residents get along with each other and the attendings. There are not a lot of other residents at the hospital (we have OB/GYN, FP, IM, and Psych residents). There are no surgery fellowships at this time but one is planned for in critical care. The hospital is very nice; there have been many recent additions and renovations. The Roanoke area is very beautiful and a great place for people that like the outdoors. If you like a big city feel this is not the right place for you. The patient population is generally poor and has a low level of education. However, the people here are nice and inviting. Housing is afordable. Many of the residents own homes and have families. I have time to spend with my wife and children. We make local trips on weekends. The work is by no means easy and of course I am more tired than I have ever been. That is what I signed up for though.
I think this is an evolving program that has a good foundation and a lot of potential. We have several new faculty and a new program director. Things are far from perfect but we are headed in the right direction. It is a community program so there are attendings that we do not work with that would add to the training. Virginia Tech will be starting a medical school here in 2010 so I think many things will continue to grow. The hospital has recently moved to a clinic format so some attendings have left. I am sure that I will be prepared to be a general surgeon or ready to enter a fellowship when I am finished. About 50% of residents go into fellowships and 50% into general surgery. There is required research each year including a presentation at the end of the year. There is not a lot of basic science research available but I see that changing as the medical school opens. The faculty are helpful when it comes to performing research. No program you find (including this one) is perfect. It is a relaxed environment that will provide you with a well rounded experience and a lot of early hands on learning. This program was my first choice and I would rank it at the top if I had it to do over again. Feel free to contact me if you have any questions.
In this program, there are still significant issues with meeting 80 hour guidelines. There is a punitive system in place, but attendings still create resident schedules that are not in compliance with the rules. Start rounding between 5:30 and 6 most days, finish the day between 5 and 6 most days, and the OR opens at 7:15. There is formal morning report. If we are on call, it goes from 7 am to the next 7 am. If not, we round early, discuss or round with the appropriate attending, and leave. The program is becoming top heavy in terms of operating as the PD expects high numbers from the residents. Call as an intern is about 4-5 times per month. PG2-3 is 5-6 per month, PG4-5 is 5-6 per month.
There have been significant changes and a lot of teaching has become belittling. Our recent medical students have witnessed this and been quite turned off to surgery, which is unfortunate. Self directed learning is the primary learning modality, but occasionally attendings will take an interest and participate in teaching. Some are much better than most.
Our environment has changed as well. There is less camaraderie, although overall residents do get along. Attending-resident relationships are becoming strained, but used to be better. There is a lot of construction and the medical system here is transitioning from a private hospital to a clinic model. The physical environment is good, and overall ancillary services are very good.
So much has changed that I would not choose this program again. Look carefully when you apply.
I usually begin my day between 5:30 and 6:00 with rounds. Morning report is at 6:45 on weekdays. We go to the OR or to educational conference. 2 afternoons a week in clinic. Afternoon rounds are brief and I usually leve by 5:00 pm. Weekends I start with morning report at 7:00 then do rounds and usually leqve by 10:00.
Faculty are typically very approachable and willing to acept discussion. There are some who are very good about teaching and others who tend to do their own thing unless you ask questions. OR experience is very good for year level. Weekly conferences follow a standard basic science text. The educational environment here is changing and will continue to improve.
Atmosphere here is great. I enjoy the people I work with (residents, faculty, nurses and other staff). No scut. Ancillary services are great. Program is not malignant at all. It's a nice environment to work in and I am happy to be here. I have a life outside of work that is very busy with a lot going on - so there is time to do other things. Roanoke is a great city. I enjoy the people and find plenty to do. The hospital is very nice and growing. Carilion is investing a lot in its facility and in our education.
Great environment here. It's a growing and developing program with good people. I would definitely choose this program again if I had to reapply. Fellowships are easily obtainable. It's a great place for my famliy. Cost of living is low. I highly recommend it.
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