Western Reserve Hospital offers a 5 year learning and residency program in General Surgery as outlined by the American College of Osteopathic Surgeons and the American Osteopathic Association Committee on Post Doctoral Training. The WRH administration, Graduate Medical Education Department, and surgical faculty are committed to provide the necessary training and resources in the development of competent Osteopathic specialists in General Surgery. Past graduates of the WRH General Surgery Resident program have obtained fellowship training opportunities in trauma, plastic surgery, and breast reconstruction.
The mission of the WRH General Surgery residency program is to develop a competent osteopathic physician, skilled in the practice of General Surgery and surgical techniques. This is accomplished by meeting or exceeding educational goals and objectives through competency based, compassionate, patient-centered learning strategies. WRH provides an opportunity to become academically and procedurally proficient through training in general, vascular, thoracic, laparoscopic, plastic, head and neck, trauma, gynecological, oncological and urological surgical procedures. Clinical exposure to all age groups, along with instruction in text, journal, and electronic resources is accomplished throughout the 5 years. The ultimate goal of our training program is excellence in patient care, recognized by colleagues and patients alike.
Through innovative design and faculty commitment, WRH General Surgery residents develop efficient, comprehensive, diagnostic and clinical reasoning skills in a progressive fashion during their 5 years of training. Beginning the first week of residency, residents are taught to develop an understanding and correlation of laboratory procedures, including clinical laboratory, radiological, pathological, and nuclear departments. The program teaches the understanding of deviations from normal physiology in all phases of bodily function and body chemistry, including the use of osteopathic manipulative therapy.
Through early intra-operative participation, the first years of the WRH surgical program emphasize the study of surgical anatomy, pathology (both gross and microscopic), physiology and physiological functions, and basic surgical techniques. This is accomplished through text, electronic, bedside, and simulation training. Procedures and skills, such as central lines, arterial lines, and chest tubes, are evaluated through videotaped human patient simulator labs until competence is evident. Each resident is then given the privilege to perform these procedures in the clinical setting.
In the later years, exposure is gained in the operative suite as each resident progresses individually. Subspecialty rotations in trauma, vascular, burns, and plastic surgery, complement strong general surgical experiences. All residents gain experience in single port laparoscopy through the Institute for Minimally Invasive Therapeutics at Akron City Hospital. During the 4th year of training, each resident is required to successfully complete the Fundamentals of Laparoscopic Surgery (FLS) course. As resident competency is demonstrated, increased exposure and responsibility is given in both the operating room and patient care, until the final year of training, where the general surgery chief resident is expected to further hone and develop his/her skills for future private practice.
Before beginning the WRH General Surgery program, incoming OGME-1 residents are mailed an advanced Ethicon suture simulation kit to practice knot tying skills and suture techniques. These skills are evaluated during the first week of residency in the General Surgery Boot Camp, where 1st year surgical residents from 4 disciplines undergo a week of intensive training.
Throughout the General Surgery training program each resident spends 1/2 day per week in a direct outpatient care setting, learning office management skills, out-patient diagnostic skills, and pre/post operative management.
The following is the schedule for the WRH General Surgery program:
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During his/her first year, the resident will receive most surgical education outside the operating room along with operating room participation. The main emphasis is on pre-operative diagnosis and post-operative care to be correlated with intra-operative anatomy and surgical findings. The special services of General Medicine/Nuclear Medicine and Pathology/Radiology, Anesthesiology/Recovery Room/Pulmonary Medicine will be highlighted. During these services, there will be limited surgical responsibilities.
The main focus for this service will be on pre-operative evaluation of patients (consultations) as to surgical risk and pre-operative and post-operative medical orders. Residents will evaluate patients osteopathically in regards to body systems and functioning, along with interpretation of diagnostic testing to aid in diagnosis. During this year special emphasis is placed upon endoscopy, laboratory evaluation, nutritional assessment, including enteral and parenteral hyper-alimentation, and management of the critical patient in ICU/CCU.
Each resident will examine gross surgical specimens following their removal, including microscopic examination of pathological and normal tissue. Residents must participate in autopsies. Special radiological procedures are taught involving an understanding of ultrasonography and CT scanning. Residents must correlate patient examinations with radiology findings, including discussion with attending Radiologists. By the end of year 1, residents must be able to evaluate a pre-operative chest film and read all x-ray films prior to surgery. Specific reading assignments and indications for procedures will be covered. Residents are exposed to radiation oncology, including a linear accelerator and betatron.
The resident will learn pre-op anesthetic evaluation as well as pre-op anesthetic orders. He/she will learn induction, intubation, and spinal anesthesia, as well as examine all surgical patients, pre- and post-operatively. The resident will evaluate anesthesia risk (R/R both surgical and anesthetic management of unconscious patient), including emphasis on anaphylactic reaction, local anesthesia, and epidural anesthesia.
During the residents second year, considerable time will be spent in the operating room to learn assisting, surgical principles, surgical techniques, and performing minor surgeries. Ten months will be spent with general surgeons with adequate time in vascular, plastics, urology, cardiothoracic, head and neck surgery, and endoscopic procedures. Two months are spent at Akron City Hospital in Trauma Surgery and in the Surgical ICU.
The resident's main emphasis during year three is in surgical assisting and performing surgery under supervision. Six months will be spent in general surgical rotation. The resident will be given considerable responsibility in pre- and post-operative management. Rotations are to include 2 months of pediatrics and burn care at Akron Children's Hospital and three months at Robinson Memorial Hospital, for focused training in hepato-biliary, colorectal, and breast disease. There is a 1 month surgical selective offered during year 3 to allow for rotations in the residents' area of interest or desired fellowship training.
The fourth year is spent performing major surgery under supervision. The resident will be assigned cases for total surgical care based on level of competency. A period of eight months is spent in general surgery and the surgical subspecialties. Three months are spent at Robinson Memorial Hospital for advanced care in abdominal and colorectal disease management. A one month surgical selective is offered during this year for interested areas of training. During year 4, each resident will continue to expand his/her knowledge base in the same areas encountered during the first three years of residency. He/she will also assume additional responsibilities of surgical boarding and instructing the junior residents and medical students in the surgical care of patients.
During this year, each resident is taught advanced surgical skills and assumes a majority of the care of patients, with appropriate attending physician supervision. The senior resident spends the entire training year at WRH, with preference given to his/her participation in selected operative interventions. These experiences are based on the needs of the resident, in areas where he/she feels that exposure will help prepare him/her for private practice or fellowship. A close working relationship is developed between attending physician and resident, with dependence on each for competent patient care and a quality educational experience.
Throughout each year, there are numerous didactic activities which are required. Through a statewide affiliation, there are monthly Resident Program and Advisory Committee (RPAC) educational meetings, which cover practice management, evidence-based medicine, trauma, transplant, and research skills. These sessions are collaborated by the Ohio University College of Osteopathic Medicine and CORE General Surgery Residency programs from across the state of Ohio.
There are weekly board review in which residents from multiple Akron area training programs review a selected surgical text. The text reviewed, as well as the accompanying board review is chosen on a yearly basis, and the session is supervised by multiple surgical attending physician faculty. All residents must participate in the ACOS General Service In-Service Exam yearly.
All WRH residents must attend both a monthly tumor board session and mortality review conference. These review any surgical oncologic cases as well as any pre-operative diagnostic challenges for current cases. There is attendance by the primary care physician, as well as all disciplines involved in the patient care plan including radiology, oncology, radiation oncology, pathology, and surgery.
There is also noon lecture, grand rounds, OMM, and morning report lectures each Tuesday through Thursday on a rotating basis.
General Surgery Didactics 2015-2016
Rick Gemma, DO Program Director Western Reserve Hospital, General Surgery
Nathan Cain, DOPGY-IV
Ohio University College of Osteopathic Medicine
Travis Dugger, DOPGY-IV
Maureen Cheung, DOPGY-III
Logan Mellert, DOPGY-III
Ohio University of Osteopathic Medicine
Roxanne McMillan, DOPGY-II
Lake Erie College of Osteopathic Medicine
Shawn Clark, DOPGY-II
Chase Beach, DOPGY-I
Jilian Nicholas, DOPGY-I
West Virginia School of Osteopathic Medicine