Rotations

PGY-1

General and Subspecialty Surgery (A, B, D)
Vascular Surgery (C)
Night Float
ER

PGY-2

General and Subspecialty Surgery (A, B, D)
Vascular Surgery (C)
Consult
SICU
Burn
Transplant

PGY-3

General and Subspecialty Surgery (A, B, D)
Vascular Surgery (C)
Pediatric Surgery
Consult
Endoscopy
Cardiothoracic

PGY-4

General and Subspecialty Surgery (A, B, D)
Vascular Surgery (C)

PGY-5

General and Subspecialty Surgery (A, B, D)
Vascular Surgery (C)
Administrative 

Rotation Descriptions


Transplant

The four-week rotation to The New York Presbyterian Hospital at Columbia focuses on the operative and critical care management of patients undergoing liver transplant and renal surgery. Not only are residents afforded operative exposure to this technically challenging procedure, post-operative management provides an excellent review of the basic science of immunology. An added feature of the rotation is the resident's participation with teams that visit area hospitals for organ harvest. The Medical Center is a busy institution that receives patients referred from the entire eastern U.S.


Cardiothoracic

Cardiothoracic Surgery is a four week rotation at NYHQ. The PGY3 is exposed to the management of patients undergoing coronary artery bypass grafting, valvular surgery, and thoracic procedures.   Depending upon motivation and interest, the resident may choose to scrub on a varying number of cardiac cases. Operative and critical care teaching is excellent, and the call schedule is a pleasant one.



Endoscopy

The goals of the Endoscopy rotation are to teach residents the use of endoscopic equipment and techniques.   The residents will be trained for indications in upper and lower endoscopy as well as endoscopic retrograde cholangiopancreatography (ERCP).



Electives

PGY 4 year residents get to choose any surgical elective. All electives are to be approved by the program director.
Electives chosen by residents include plastics, colo-rectal, and pediatrics, just to name a few. The resident gains a more focused experience in the elective of his or her choice and is given to opportunity to meet renowned faculty at other institutions.


General Surgery

As in all residencies, the core experience for our trainees is in General Surgery. While recent years have seen a diminution in those procedures performed by the generalist, our residency is uniquely structured to educate truly well rounded and experienced practitioners. Surgical residents at NYHQ are able to consider all procedure types "their own," and are limited in exposure only by their own interest.

No procedures, even the most sophisticated, are relegated to fellows, allowing general surgery residents to explore all areas into which their curiosity takes them. While many of our graduates go on to fellowships in the various specialties, others find themselves superbly prepared to practice the broadest type of surgery in places where subspecialists are few in number.

The program prides itself on the broad-ranging capabilities of its residents. Although it is rare that a graduate practices all specialty procedures, competency in and confidence with the treatment of the following is usual:

Gastrointestinal Surgery

  • Cholecystectomy (open and laparoscopic)
  • Common bile duct exploration (open and endoscopic)
  • Gastrectomy (subtotal and total)
  • Pancreatectomy (head and body)
  • Hepatectomy
  • Small bowel resection (for trauma, tumor, ischemia, and inflammatory bowel disease)
  • Colonic resection (open and laparoscopic)
  • Low anterior resection (including nerve sparing procedures)
  • Abdominoperineal resection
  • Surgery for peri-anal disease
  • Abdominal Wall Surgery
  • Groin herniorrhaphy (open and endoscopic)
  • Ventral herniorrhaphy (open and laparoscopic)
  • Abdominal wall resection for tumor

Breast Surgery

  • Biopsy (open, needle-directed, stereotactic, FNA)
  • Breast conserving surgery for cancer (lumpectomy and quadrantectomy)
  • Mastectomy (total and modified radical)
  • Axillary lymphadenectomy, sentinal node

Thoracic Surgery

  • Lung biopsy (open and thoracoscopic)
  • Mediastinoscopy
  • Wedge resection (open and thoracoscopic)
  • Lobectomy Pneumonectomy

Head and Neck Surgery

  • Thyroidectomy (subtotal and total)
  • Parathyroidectomy
  • Parotidectomy
  • Excision of neck masses
  • Radical neck dissection
  • Tracheostomy

Trauma Surgery

  • Exploratory laparotomy ( penetrating and blunt trauma)
  • Thoracotomy
  • Splenectomy
  • Splenorrhaphy
  • Bowel resection
  • Vena caval injuries
  • Neck and extremity exploration for vascular injury

Vascular Surgery

  • AV Fistula creation
  • Vascular access procedures
  • Femoro-popliteal and distal bypass
  • Abdominal aortic aneurym surgery
  • Carotid endarterectomy
  • Endovascular procedures

Urological Surgery

  • Hydrocelectomy
  • Circumcision
  • Open prostatectomy
  • Bladder resection
  • Nephrectomy (open and laparoscopic)

Gynecological Surgery

  • Abdominal hysterectomy
  • Oophorectomy

Plastic Surgery

  • Excision of cutaneous malignancy
  • Skin grafting (minor and major)

In addition, graduating residents are versed in all aspects of Critical Care and invasive monitoring as it relates to the trauma patient, the complex post-operative patient, and those with multi-organ failure (including burn patients).

Specialties

Surgical residents at New York Hospital Queens have unique exposure to the surgical subspecialties. Each of the institution's subspecialty divisions are capable of the most sophisticated interventions and allof them perform large numbers of procedures with participation of general surgery residents. Because there are no fellows in any of the specialty areas, general surgery residents have full access to specialty patients, and indeed, are responsible for participation in their care.


Urology
Patients with major urologic pathology such as kidney tumors and other conditions requiring major surgery are managed and operated upon by the surgical residents at NYHQ under the direction of the urologists. By performing procedures such as nephrectomies for cancer, the senior residents become facile with surgery of the retroperitoneum and adrenal gland.


Gynecology
Gynecologic exposure is obtained in a number of ways. Interaction between services in the emergency evaluation of abdominal pain presents the first level of learning. In cases where both specialties are involved, surgical residents will scrub with both the surgical and gynecologic attendings, allowing exposure to all technical aspects of the procedure at hand. The most critically ill of gynecologic patients are treated in the SICU where surgical residents make decisions in conjunction with the Critical Care and Gynecological staff.


Orthopaedics
The trauma rotation during all five years of residency exposes the resident to complex fractures, their attendant potential for associated neurovascular injury, and the appropriate methods of wound management. The rotation includes fracture assessment in the ER, surgical management, and follow-up in the clinic. The learning experience is enhanced by the addition of four orthopaedic residents now rotating at NYHQ from the Hospital For Special Surgery.


Neurosurgery
Neurological surgery experience is obtained in three locations. In the ER and through associated didactics, the resident learns the routine assessment of the head-injured patient. In the SICU, the resident is exposed to the most seriously ill, brain-injured patients, and becomes knowledgeable in their pathophysiology and adept in their management. Finally, neurosurgery patients are admitted to one of the general surgery teams so that residents are able to follow them throughout their course and participate in the operating room.


Plastic Surgery
The Plastic Surgery exposure is extensive for the interested resident. Principles of plastic surgery are taught to all house staff on ward rounds and in the classroom where the "Plastic Surgery for General Surgeons" series covers all major areas of the specialty. Residents become adept at grafting and are able to actively participate in more complex reconstructive procedures after trauma and tumor ablation. Residents performing cancer operations that are to be immediately reconstructed are encouraged to also participate in the restorative procedures that follow. The house staff will follow and care for these patients under the direction of both the ablative and the restorative surgeon.


Head and Neck
Experience in ablative head and neck surgery is notable, with residents able to perform thyroid, parotid and oral surgery under the direction of experienced staff. Major ablative operations for oropharyngeal cancers are commonly performed with the resident taught the principles of head and neck work up and the techniques of tumor extirpation and radical neck dissection.


Colo-Rectal
Resident experience in colo-rectal surgery is extensive at NYHQ. The wealth of clinical material and the absence of fellows have made it possible for interested residents to perform as many as 100 colonic resections during their tenure here. Chairman Turner's support of the division's program in cutting-edge techniques has made possible a resident experience equal to some fellowships in colo-rectal surgery. Busy colo-rectal specialists instruct and supervise house staff in the latest techniques including nerve-sparing low anterior resections and laparoscopic colectomy.

As a prelude to clinical laparoscopy, Division Director, Stephen Merola, MD, takes each resident through a 6-week laparoscopy course which includes didactics, technical practice sessions, and animal laboratory work. Surgical residents rotating to endoscopy at Flushing Hospital Medical Center are given the opportunity to perform all forms of endoscopy and have universally praised the experience gained.

Residents also become well versed in the ambulatory treatment of more common problems of the anal canal and transanal surgery.Rectal prolapse procedures, transanal cancer ablations, and treatment of rectovaginal fistulas are numerous.

Laparoscopic Surgery Education
The education of today's future general surgeons must put a strong emphasis on laparoscopy.   The Division of Minimally Invasive Surgery at New York Hospital Queens specializes in this surgical approach.   Within this division are surgeons who perform a number of minimally invasive operations including: obesity surgery, colon surgery, hiatal hernia surgery, inguinal and incisional hernia surgery, removal of the spleen or adrenal gland, gallbladder surgery, and removal of the appendix.

By the time residents finish their surgical training at NYHQ, they have been exposed to the vast majority of operations that are currently performed laparoscopically.   In addition to the broad exposure residents gain in the operating room, there is a dedicated surgical skills laboratory, which contains a videotape library of various laparoscopic operations, and a computerized laparoscopic curriculum as well as three inanimate trainers.   The trainers allow residents to practice a number of skills including the use of two hands and both intracorporeal and extracorporeal knot-tying.   Much of the teaching in the laboratory is done by the Minimally Invasive Fellow whose office is situated in the lab, as is the office of the Director of Minimally Invasive Surgery.   There is 24-hour card access to the skills laboratory.


Thoracic
Residents at NYHQ participate in all thoracic procedures, with most of these performed by the residents under the tutelage of staff specialists. This rotation provides teaching leading to resident proficiency in thoracotomy, open lung biopsy, and pulmonary lobectomy/pneumonectomy, as well as cardiac pacemaker placement. Junior residents rotating on the Cardio-thoracic service act as "chiefs" of the thoracic section, and are given significant responsibility in the care of the institution's thoracic inpatients.

With the advent of our new, Cardio-thoracic program two years ago, new thoracic procedures have been introduced to the institution and the resident experience. Working with Wilson Ko, MD, residents are developing increasing experience with thoracoscopic surgery, performing blebectomies, biopsies, wedge resections, decortications, and sympathectomies with the aid of the thoracic endoscope.

Thoracoscopy has also had an impact upon the performance of combined procedures such as esophagectomy, where esophageal mobilization for resection and gastric pull-up is performed without need for open thoracotomy.


Trauma
Expertise in the care of the trauma patient is an important component of a general surgeon's armamentarium, and the trauma service provides the framework for our program to build upon. From the PGY-1 year onward through a process of supervised and graded responsibility, our surgical residents become facile and familiar with all aspects of the initial triage, resuscitation and management of the multiply injured and critically ill patient.
Caring for trauma patients requires an understanding of the pathophysiology of many organ systems and an ability to triage each system in the treatment process. It also provides the senior resident opportunity to be "captain of the ship;" acting as the coordinator of care provided by disparate subspecialties.

Under the direction of Kenneth Rifkind, MD, the training program at the NYHQ provides an excellent background for the trauma service. There are no residency programs in the surgical subspecialties, and as a result, our residents may add to their general surgical prowess an understanding of the pathophysiology and treatment of surgical conditions within subspecialty areas such as thoracic, peripheral vascular, urologic, plastic and neurosurgery. This provides a basis for excellent communication between the members of the trauma team and prevents fragmentation of care among various subspecialty support groups.

The members of the trauma team and the entire surgical house staff meet weekly to discuss all admissions to the trauma service for the week. Although more time is given to some cases than others, this conference permits contemporaneous review of all current problems. Also, this multidisciplinary conference includes paramedics involved in the pre-hospital phase of care, allowing a broad critique of treatment decisions and the development of superior treatment protocols.

The Trauma Service rotation provides a forum for the resident to expand his/her academic horizons. Each resident beginning at the PGY-1 level is required to become an "expert" on a particular aspect of trauma care and research, developing and delivering an hour long presentation on the topic at our multidisciplinary trauma conference. The resident is assigned an advisor to assist in the design of the presentation and the creation of visual aids. Each presentation results in a treatment algorithm that is incorporated into our trauma protocol book. These presentations prepare the resident for presentations to larger audiences outside the institution.


Oncology
Surgical Oncology has long played a fundamental role in the academic and teaching experience at NYHQ. Our ever-growing population of surgical oncology patients is reflected in the ratio of newly registered (tumor registry) patients to hospital beds. While at many institutions this is 1:1, at NYHQ it is between 4 and 5:1. Residents are involved in the care of patients with virtually every tumor type, ranging from breast and colon malignancies to oropharyngeal and urologic carcinomas, and the sarcomas.

The practice of surgical oncology is interdisciplinary in nature and requires coordination between the surgeon, radiation oncologist and medical oncologist. This cooperative approach is demonstrated at our Tumor Board conferences where patients with all tumor types are discussed among the specialties. Each section is headed by a board certified specialist who is both an active clinician and a dedicated teacher. Active resident participation is expected at the Tumor Board Conference where a full command of the literature is expected. Residents employ state-of-the-art audiovisual teaching aids for the presentation of pathology slides and x-rays.  Tumor Board has been evaluated by residents and students alike as one of the finest conferences at the institution.

In addition to the institutional Tumor Board, NYHQ supports subspecialty Tumor Boards in breast, gynecology, head and neck cancer, and other areas. Within these, a more focused approach to tumors routinely treated by the specialties is undertaken. Our residents participate in the care of all subspecialty patients and find that much of the information gleaned can be applied to more general surgical problems.

Through these mechanisms, as well as via Journal Club and Basic Science didactic courses, residents gain an excellent, far-ranging understanding of oncologic topics. This understanding is put to work in their required clinical research endeavors. The extensive database of the tumor registry has proven an excellent starting point for these academic pursuits.

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